Citation Nr: 18158996 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-40 013 DATE: December 18, 2018 ORDER New and material evidence has been received to reopen a previously denied claim of service connection for an acquired psychiatric disorder, and the application to reopen is allowed; to this extent only, the claim is granted. New and material evidence has been received to reopen a previously denied claim of service connection for a prostate condition, and the application to reopen is allowed; to this extent only, the claim is granted. Entitlement to service connection for a sleep condition is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for rocky mountain spotted fever (RMSF) is denied. Entitlement to an initial rating higher than 10 percent for bilateral hearing loss is denied. Entitlement to an initial rating higher than 10 percent for tinnitus is denied. Entitlement to an effective date earlier than September 11, 2014, for the grant of service connection for bilateral hearing loss, is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder, adjustment disorder, and depression, is remanded. Entitlement to service connection for a prostate condition, to include prostate cancer, is remanded. Entitlement to service connection for a headache disability is remanded. Entitlement to an effective date earlier than September 11, 2014, for the grant of service connection for tinnitus is remanded. FINDINGS OF FACT 1. In an unappealed September 1967 rating decision, the RO denied the Veteran’s original claim for service connection for a psychiatric disorder, claimed as a nervous condition. 2. Evidence received since the final September 1967 rating decision was not previously of record, and raises a reasonable possibility of substantiating the claim of service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder. 3. In an unappealed March 1968 rating decision, the RO denied the Veteran’s original claim for service connection for a prostate condition. 4. Evidence received since the final March 1968 rating decision was not previously of record, and raises a reasonable possibility of substantiating the claim of service connection for a prostate condition, to include prostate cancer. 5. The Veteran does not have a current diagnosis of a chronic sleep condition. 6. The record contains no competent lay or medical evidence of any injury or disease incurred in service relating to a cervical spine disability. 7. The record contains no competent lay or medical evidence of any injury or disease incurred in service relating to a lumbar spine disability. 8. The record contains no competent lay or medical evidence of any injury or disease incurred in service relating to hypertension. 9. The record contains no competent lay or medical evidence of any injury or disease incurred in service relating to RMSF. 10. For the entire initial period on appeal, the Veteran’s bilateral hearing loss manifested by hearing acuity no worse than Level II in the right ear and Level V in the left ear and speech recognition ability not worse than 88 percent in the right ear and 68 percent in the left ear. 11. The Veteran’s service-connected bilateral tinnitus is assigned a 10 percent disability rating, which the maximum is rating authorized for tinnitus under Diagnostic Code 6260, for either a unilateral or bilateral condition. 12. On September 11, 2014, VA received the Veteran’s fully developed claim for compensation for bilateral hearing loss, and there was no formal or informal claim prior to that date. CONCLUSIONS OF LAW 1. The September 1967 rating decision denying service connection for a nervous condition is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.105(a), 20.302, 20.1103 (2017). 2. The additional evidence received since the September 1967 rating decision is new and material, and the claim of service connection for an acquired psychiatric disorder is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 3. The March 1968 rating decision denying service connection for a prostate condition is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.105(a), 20.302, 20.1103 (2017). 4. The additional evidence received since the March 1968 rating decision is new and material, and the claim of service connection for a prostate condition is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 5. The criteria to establish service connection for a sleep condition are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 6. The criteria to establish service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 7. The criteria to establish service connection for a lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 8. The criteria to establish service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 9. The criteria to establish service connection for RMSF are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 10. For the entire period on appeal, the criteria for an initial rating higher than 10 percent, for bilateral hearing loss disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 3.383, 4.85, 4.86, Diagnostic Code 6100. 11. The criteria for an initial disability rating higher than 10 percent for bilateral tinnitus are not met. 38 C.F.R. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.87, Diagnostic Code 6260 (2017). 12. The criteria for an effective date earlier than September 11, 2014, for the grant of service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1964 to October 1965. 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). 1. New and Material Evidence 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 by filing a NOD with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160, 20.201, 20.302 (2017). A decision also does not become final if new and material evidence is received within one year. An exception to the finality rule is found in 38 U.S.C. § 5108, which provides that, if new and material evidence is received with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. 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. Anglin v. West, 203 F.3d 1343, 1347 (2000). In deciding whether new and material evidence has been received, 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.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). a. An Acquired Psychiatric Disorder Here, the RO denied the Veteran’s service connection claim for a nervous condition in a September 1967 rating decision, finding that the Veteran had a diagnosis of a personality disorder with adjustment disorder that pre-existed service and was not aggravated by it, and led to his discharge. The evidence considered at the time included the Veteran’s service treatment records and discharge information. The Veteran did not appeal the decision, and new and material evidence was not received within one year of the decision. Thus, the September 1967 rating decision became final. See 38 U.S.C. § 7105 (d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. Relevant evidence received since the September 1967 denial of the claim includes the Veteran’s petition to reopen, VA and private treatment records, lay assertions from the Veteran’s family members, and a July 2016 private disability benefits questionnaire (DBQ). This evidence, specifically the treatment records showing a diagnosis of unspecified anxiety disorder and the private psychologist’s opinion that it had its onset during active service, relates to the unestablished element of a nexus in the prior denial. The additional evidence received since the September 1967 final denial is therefore new and material. The criteria for reopening the claim for service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder, are therefore met. b. Prostate Condition Here, the RO denied the Veteran’s service connection claim for a prostate condition in a March 1968 rating decision, finding that the Veteran did not have a current diagnosis. The evidence considered at the time included the Veteran’s service treatment records and a February 1968 VA examination report. The Veteran did not appeal the decision, and new and material evidence was not received within one year of the decision. Thus, the March 1968 rating decision became final. See 38 U.S.C. § 7105(d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. Relevant evidence received since the March 1968 denial of the claim includes the Veteran’s petition to reopen and VA and private treatment records. This evidence, specifically the treatment records showing a diagnosis of prostate cancer and other prostate conditions relates to the unestablished element in the prior denial. The additional evidence received since the March 1968 final denial is therefore new and material. The criteria for reopening the claim for service connection for a prostate condition, to include prostate cancer, are therefore met. 2. Service Connection Claims 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 service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 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). The Veteran is currently diagnosed with arthritis of the cervical and lumbar spine, and hypertension, which are considered a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in-service symptoms and “continuous” post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For a showing of a chronic disorder in service, the mere use of the word chronic will not suffice; rather, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. 38 C.F.R. § 3.303(b). Continuity of symptomatology after service is required where a condition noted during service is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. Id. The presumptive service connection provisions based on “chronic” in-service symptoms and “continuity of symptomatology” after service under 38 C.F.R. § 3.303(b) have been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013) (holding that the “chronic” in service and “continuous” post-service symptom presumptive provisions of 38 C.F.R. § 3.303(b) only apply to “chronic” diseases at 3.309(a)). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107 (b)). The Veteran has generally asserted that his sleep condition; cervical spine; lumbar spine; hypertension; and, RMSF disabilities are related to his military service; however, he has not identified any in-service incurrence of a disease or injury for any of these disabilities. Nor has he provided any explanation for why or how he believes the claimed disabilities were related to service. A mere conclusory generalized lay statement that a service event or illness caused the claimant’s current condition is insufficient to establish medical etiology or nexus. Waters v. Shinseki, 601 F.3d 1274 (2010). Therefore, the Board finds the Veteran’s lay statements as to incurrence and nexus are not competent or probative. The Veteran has not been provided with VA examinations for any of the service connection claimed disabilities denied by the Board herein. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in initial service connection claims, the VA must provide a VA medical examination where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. Here, there is simply no lay or medical evidence establishing that an event, injury, or disease occurred in service for the Veteran’s service connection claims for a sleep condition; cervical spine; lumbar spine; hypertension; and, RMSF disabilities. He has provided no assertions of any in-service disease or injury relevant to these conditions or of how or why he believes they are related to service. In essence, the Veteran has merely filed these claims with no further details. A mere conclusory generalized lay statement that military service caused the claimant’s current condition is insufficient to require an examination under McLendon. Waters, 601 F.3d at 1278-79 (rejecting appellant’s argument that his “conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of [38 U.S.C. § 5103A(d)(2)(B).]”). The record contains no relevant chronic symptoms in service, no credible evidence of continuous symptoms after service, and no suggestion in the medical evidence that any of the claimed conditions are related to service in some way. In fact, the medical evidence clearly shows the onset of these disabilities decades post service. Again, as noted above, the Veteran had not identified any in-service incurrence of a disease or injury for any of these disabilities and did not even provide any explanation for why or how he believed the claimed disabilities were related to service. For these reasons, service connection on a direct basis is denied for all of the service connection claims. While VA treatment records beginning in 2014 showed a diagnosis of RMSF, likely as a result of a tick bite, there is absolutely no evidence - lay or medical - linking this disability to the Veteran’s active duty service almost five-decades earlier. At the time of the diagnosis in fall of 2014, the Veteran had reported several tick bites over the prior spring and summer, with no statements of any military events. Regarding the claims for service connection for cervical spine, lumbar spine, and hypertension, as aforementioned, arthritis and hypertension are considered a “chronic disease” and as such is subject to presumptive service connection. Here, there is first no showing of a chronic disease in service and second no showing any of these conditions manifested to a degree of 10 percent within one year after separation from service. Finally, there is no credible evidence of continuity of symptomatology. First, the Veteran’s service treatment records are silent to any complaints, treatment, or diagnoses of cervical and lumbar spine disabilities or hypertension. His separation examination showed normal spine/musculoskeletal system and cardiovascular system. All in-service blood pressure readings were within normal limits. Thereafter, during a February 1968 VA report of medical examination for disability evaluation, the Veteran’s blood pressure was 114/70, and his cardiovascular and musculoskeletal systems were both “negative.” Post-service, it was not until January 2004 where hypertension was noted in the Veteran’s problem list and not until August 2005 where arthritis of the cervical and lumbar spine was noted. Additional VA treatment records dated in May 2005 noted that the Veteran had no history of a cervical spine disease and his neck extension was normal. Thereafter, treatment records dated in August 2005 showed that the Veteran had a past medical history of cervicalgia and arthritis of the neck and back. Subsequent VA treatment records dated in February 2006 showed somewhat elevated isolated blood pressure reading of 140/70, but March 2006 treatment records showed normal blood pressure readings. The February 2006 treatment records indicated that the Veteran’s father died from hypertension and the Veteran denied any history of hypertension. Also in February 2006, it was noted that the Veteran denied any history of arthritis or gout. Additional treatment records starting in 2009 noted diagnosis of hypertension. Subsequent records dated in June 2015 noted that the Veteran stated that he was injured in a rear-end collision motor vehicle accident in 2009 and also fell that year. To the extent that the Veteran asserts that his symptoms have being continuous since service, such statements are not credible and contradicted by the evidence of record. The current assertions made for VA compensation purposes are not credible, because they are contradicted and outweighed by the more contemporaneous lay and medical evidence, including the Veteran’s own statements at service separation and for decades post-service. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In addition, the U.S. Court of Appeals for Veterans Claims, in Savage v. Gober, 10 Vet. App. 488, 496-97 (1997), agreed that in a case where the Veteran failed to present medical nexus evidence relating currently diagnosed arthritis to in-service injury along with lack of evidence of treatments may bear on the credibility of the evidence of continuity. Notably, no medical professional opined that any of these disabilities were related to the Veteran’s service. 3. Increased Rating Claims Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). a. Increased Rating for Hearing Loss Under DC 6100, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examination. Evaluations of hearing impairment range from non-compensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000; 2000; 3000; and 4000 Hertz (cycles per second). To evaluate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, DC 6100. As set forth in the regulations, Tables VI, VIA, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, DC 6100. Hearing tests will be conducted without hearing aids, and the results are charted on Table VI and Table VII. See 38 C.F.R. § 4.85. Alternatively, VA regulations provide that in cases of exceptional hearing loss, when the pure tone thresholds at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). The provisions of 38 C.F.R. § 4.86(b) further provide that, when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever would result in the higher numeral. In addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in the final report. See Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran’s bilateral hearing loss is rated as 10 percent disabling for the entire initial rating period on appeal. The Veteran asserts that his hearing loss is worse than the currently assigned disability rating. A review of the Veteran’s VA treatment records dated from September 2013 to December 2014 showed complaints of difficulty hearing when other people speak, but do not include any audiometric findings. At the December 2014 VA audiology examination, pure tone thresholds, in decibels, were recorded as follow: HERTZ AVG 1000 2000 3000 4000 RIGHT 41 15 30 50 70 LEFT 50 30 50 55 65 Speech audiometry revealed speech recognition ability of 88 percent in the right ear and 68 percent in the left ear. The examiner noted that the test results were valid for rating purposes. Regarding functional effects of the Veteran’s hearing loss, the examiner stated that the he reported difficulty hearing his wife’s voice in the absence of visual cues and said that he needed frequent repetition. Here, applying the December 2014 audiometric result to Table VII, the Veteran had Level II hearing acuity in the right ear and Level V hearing acuity in the left ear, resulting in a 10 percent rating. 38 C.F.R. § 4.85, DC 6100. An exceptional hearing pattern was not demonstrated. Subsequent VA treatment records are silent for any complaints or treatment related to the Veteran’s hearing loss. The Board considered whether a rating higher than 10 percent is warranted; however, in determining the actual degree of disability, an objective examination is more probative of the degree of the Veteran’s impairment. Furthermore, the opinions and observations of the Veteran alone are not sufficient to address the rating criteria under 38 C.F.R. § 4.85, DC 6100 with respect to determining the severity of his service-connected left ear hearing loss disability. See Moray v. Brown, 2 Vet. App. 211, 214 (1993); see also 38 C.F.R. § 3.159(a)(1) and (2). Accordingly, there is no basis to support entitlement to a rating higher than 10 percent for the Veteran’s service-connected bilateral hearing loss during this period on appeal. As a preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt rule does not apply, and the claim must be denied. b. Increased Rating for Tinnitus Throughout the entire initial rating period on appeal, the Veteran has been in receipt of a 10 percent disability rating for bilateral tinnitus under 38 C.F.R. § 4.87, Diagnostic Code 6260. Under Diagnostic Code 6260, 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 (2017); Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). As the maximum schedular rating for tinnitus under Diagnostic Code 6260 has already been assigned, a higher schedular rating is not available, and the Veteran’s claim for a disability rating in excess of 10 percent for bilateral tinnitus must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Finally, neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 4. Earlier Effective Date In September 2014, the Veteran filed a claim for service connection for bilateral hearing loss using the Fully Developed Claim (FDC) process; the claim is date stamped September 11, 2014. The effective date of an award of compensation based on an original claim or a claim reopened after final disallowance will be the date of receipt of the claim or the date entitlement arose, whichever is the later. See 38 C.F.R. § 3.400. Here, neither the Veteran nor his representative provided any argument or evidence in support of his claim for an earlier effective date for bilateral hearing loss. Furthermore, the Board finds that it is unclear what effective date the Veteran is in fact disagreeing with. Notably, a January 2015 rating decision granted service connection for bilateral hearing loss and assigned a noncompensable rating, effective September 11, 2014, the date of receipt of the Veteran’s claim. However, in an April 2016 rating decision, the RO acknowledged a clear and unmistakable error with the assigned disability rating, and determine that a 10 percent was warranted for the entire initial period on appeal beginning September 11, 2014. Although the claim was already in appellate status, the Veteran submitted an additional notice of disagreement, which again noted that he disagreed with both the evaluation and effective date. The RO noted that the 10 percent rating was provided for the entire initial period on appeal and an earlier effective date for the assigned rating was therefore not warranted. However, the Board finds that the Veteran disagreed with the effective date after the noncompensable rating was initially assigned, therefore, it follows that he was in disagreement with the initial effective date assigned for the grant of service connection for bilateral hearing loss. Here, given that his claim was received September 11, 2014, no earlier effective date of is warranted. He has not alleged that he filed a claim any earlier than that date. Although the regulations in effect prior to 2014 did allow for informal claims, there is nothing in the record that would qualify as such. The VA medical treatment records show that the Veteran complained of difficulty hearing for a few years prior to filing his claim. However, the mere presence of medical evidence of a disability does not show an intent on the Veteran’s part to seek service connection and therefore does not constitute a claim; rather, the Veteran must assert a claim either expressly or impliedly. VA is not required to conjure up issues not raised by the claimant. See Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995) (noting that although VA must interpret a claimant’s submissions broadly, VA is not required to conjure up issues not raised by claimant). Therefore, the Board declines to view any references to hearing loss in medical records prior to September 11, 2014, as a claim for VA compensation. Since no such prior claim had been denied, the VA medical records could not serve as a claim to reopen under the prior provisions of 38 C.F.R. § 3.157 (2014). There is otherwise no legal basis for the assignment of an effective date earlier than September 11, 2014, for the grant of service connection for bilateral hearing loss. REASONS FOR REMAND The Board finds that a remand is necessary to provide the Veteran with VA examinations for his service connection claim for an acquired psychiatric disorder, a prostate condition, and a headache disability. In addition, a remand is necessary for the RO to issue a statement of the case for the Veteran’s timely appeal of entitlement to an earlier effective date for the grant of service connection for tinnitus. An Acquired Psychiatric Disorder In support of his claim, the Veteran submitted a July 2016 private disability benefits questionnaire (DBQ), in which the psychologist diagnosed unspecified anxiety disorder. The psychologist noted that the Veteran’s induction examination was negative for any mental health issues and that throughout his 8-months service he made multiple psychosomatic complaints that resulted in the impression of inadequate personality and that he was unsuitable for further military service. For example, in August 1965, the Veteran wrote to the President about his dissatisfaction and stated that he contemplated suicide if his duty was not changed. At that time, he was diagnosed with inadequate personality. He was recommended for discharge, but his separation examination showed normal for any psychiatric disorders. The psychologist further noted that VA treatment records from 2004 to 2014 continuously showed that he was diagnosed with anxiety disorder, and referenced letters from the Veteran’s family and friends, which indicated that upon his discharge from service he had a noticeable change in behavior. The psychologist then referenced medical literature detailing an association between tinnitus and comorbid psychological disorders, including a high prevalence of anxiety and depression. The psychologist opined that the Veteran suffered from unspecified anxiety disorder that more likely than not began in military service, continued uninterrupted to the present, and was aggravated by his tinnitus and bilateral hearing loss. Upon review, however, the Board assigns little probative weight to this psychologist’s opinion. First, the psychologist selectively referenced evidence from the Veteran’s claims file. For example, VA psychiatry consult in September 2004 noted that the Veteran sought mental health treatment after being “apparently well” until three-months earlier, when he was diagnosed with early stage of prostate cancer. The Veteran reported that shortly after he found out about the diagnosis, he started feeling down with reduced motivation, poor sleep and appetite, very poor concentration, memory disturbances, and was anxious at times. This evidence contradicts the psychologist’s opinion that the diagnosed unspecified anxiety disorder continued uninterrupted since service. Second, the psychologist failed to address that after being denied service connection in 1967, the Veteran in a correspondence acknowledged the denial, and explained that he wanted to get out of the military due to his pre-existing prostate and bladder condition, at that time, he reported no psychiatric symptoms and did not appeal the denial. Lastly, the psychologist referenced the possible relationship between tinnitus and psychiatric disorders, to include anxiety, but provided no rationale as to how the generic medical literature was specific to this Veteran.   Nevertheless, given the lay reports from family members of the Veteran and the suggestion that his tinnitus might have caused or aggravated his currently diagnosed unspecified anxiety disorder, the Board finds that a new VA examination is necessary prior to making a decision on the merits. Prostate Condition, to include Prostate Cancer The Board notes the Veteran’s claim for a prostate condition was denied by the RO in 1968. At the time, it was noted that in September 1964, the Veteran reported pre-service history of treatment for a kidney infection and noted that once in a while he had a burning sensation when urinating. At the time, urinalysis was negative except for 50mg of albumin. A day later, the Veteran reported a history of at least five months of intermittent burning and nocturia four times in the previous four months. A urology workup three days later revealed nocturia two or three times with occasional dysuria with frequency and urgency. It was noted that he had a history of GU infection with frequency and urgency, which led to his rejection for Navy enlistment. Subsequently, in November 1964, he again reported a pre-service history of infection, and urinalysis was negative with no evidence of albumin or cells. A few days later, examination revealed that left lobe of his prostate was larger than the right with copious discharge produced on prostatic massage, and the Veteran was prescribed medication. At the end of November 1964, examination was essentially negative and prostatic secretions were roughly normal, and in December 1964, it was noted that the Veteran was asymptomatic. Nevertheless, in mid-January 1965, he complained of dysuria, diuria six times, nocturia two times, with crampy lower abdominal pain and cloudy urine during the previous month. Rectal examination noted that the prostate was non-tender, symmetrical, and benign. Urinalysis was essentially negative. Thereafter in July 1965, the Veteran reported with abdominal pain and noted a history of kidney and bladder trouble. Examination at the time was normal and urinalysis was negative for sugar and albumin. His separation examination was negative for any of the above conditions.   During the February 1968 VA examination, the examiner indicated that there was no evidence of prostatitis. Nevertheless, throughout the years, the Veteran was diagnosed with various prostate conditions, to include prostate cancer. Given the relevant pre-service and in-service history discussed above, the Board finds that a VA examination is necessary to determine the nature and etiology of the Veteran’s prostate conditions, to include prostate cancer and residuals thereof. Headache Disability The Board notes that a review of the available evidence revealed that in August 2005 he reported waking up in the middle of the night with terrible headaches. Thereafter, in June 2007, he denied having any headaches, and in September 2014, he reported mild headaches. The record is otherwise silent to any additional complaints, treatments, or diagnosis of a headache disability. In support of his claim, the Veteran submitted a January 2016 private DBQ, in which a family physician rendered a diagnosis of tension headaches. The physician stated, “When I spoke to the Veteran on 1/21/2016 he reported that his headaches began while he was in service and have continued to present day. He stated that the headaches have become more frequent and severe over the years.” Thereafter, the physician opined that it was as likely as not that the Veteran’s headaches were caused by his service-connected tinnitus. The physician explained that the Veteran reported that when his tinnitus flare-ups “it brings on a headache.” In this regard, the physician stated, “It is known that damage to the auditory system resulting in tinnitus can also cause headaches. Lastly, the physician attached medical literature titled “Psychological and Audiological Correlates of Perceived Tinnitus Severity.” However, there is no indication that the physician examined the Veteran and or reviewed the claims file. Second, a careful review of all the evidence does not show any reports of headaches associated with the Veteran’s tinnitus, to include during his December 2013 VA audiology examination. Lastly, the physician indicated that tinnitus “can” cause headaches, an inconclusive statement, that weights neither for or against the claim. Nevertheless, given these lay reports and the possibility that there might be a relationship between this Veteran’s tinnitus and his reported headaches, the Board finds that a VA examination is necessary prior to making a decision on the merits. Earlier Effective Date for Tinnitus In September 2014, the Veteran filed a claim for service connection for tinnitus using the Fully Developed Claim (FDC) process; the claim is date stamped September 11, 2014. Thereafter, in a January 2015 rating decision, the RO granted service connection for tinnitus effective September 11, 2014. The Veteran timely appealed the decision in February 2015, indicating that he was in disagreement with both the assigned rating and the effective date. However, in the April 2016 statement of the case, the RO failed to adjudicate whether entitlement to an earlier effective date was warranted. Hence, this claim must be remanded for issuance of an SOC. See Manlincon v. West, 12 Vet. App. 238, 240 (1999). Thus, the Board accepts limited jurisdiction over this issue for the sole purpose of remanding it to order issuance of a SOC along with information about the process for perfecting an appeal as to this claim, if the Veteran so desires. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records since April 2016 are associated with the claims file. 2. DO NOT PROCEED WITH THE FOLLOWING until the VA records are obtained to the extent possible. 3. Then, provide the Veteran with a VA examination to determine the nature and etiology of his claimed acquired psychiatric disorder. The claims file must be made available to and be reviewed by the examiner. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a thorough review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify all currently diagnosed acquired psychiatric disorders, to include previously diagnosed unspecified anxiety disorder, adjustment disorder, and depression. (b) For each currently diagnosed psychiatric disorder, provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that it had its onset during active duty service or is otherwise causally or etiologically related to it. (c) For each currently diagnosed psychiatric disorder, provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that it was caused by or aggravated by the Veteran’s service-connected bilateral hearing loss and/or tinnitus. In doing so, please specifically address the Veteran’s service treatment records, post-service treatment records, and the private July 2016 private DBQ (VBMS entries titled “Third Party Correspondence” and “other” on 08/19/2016). A complete rationale should be provided for all opinions on direct, causation, and aggravation. 4. Then, provide the Veteran with a VA examination, to determine the nature and etiology of his claimed prostate condition, to include prostate cancer. The claims file must be made available to and be reviewed by the examiner. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a thorough review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify all currently diagnosed prostate condition and or any related residual of the disability. (b) For each currently diagnosed prostate disability, provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that it had its onset during active duty service or is otherwise causally or etiologically related to it. (b) If it is concluded that any prostate disability preexisted service, provide an opinion as to whether it clearly and unmistakably preexisted service, and if so, whether it clearly and unmistakably was NOT aggravated during service. In doing so, the examiner is asked to address the Veteran’s service treatment records (as summarized above in this Remand), the Veteran’s lay assertions regarding any symptoms he experienced prior to, during, and post-service, and post-service medical treatment records. A complete rationale should be provided for all opinions on direct, causation, and aggravation. 5. Then, provide the Veteran with a with a VA examination to determine the nature and etiology of his claimed headache disability. The claims file must be made available to and be reviewed by the examiner. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a thorough review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify any currently diagnosed headache disability. In doing so, obtain information from the Veteran and the claims file as well as address the private January 2016 DBQ showing a diagnosis of tension headaches. (b) For each currently diagnosed headache disability, provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that it had its onset during active duty service or is otherwise causally or etiologically related to it. (c) For each currently diagnosed headache disability, provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that it was caused by or aggravated by the Veteran’s service-connected bilateral hearing loss and tinnitus. A complete rationale should be provided for all opinions on direct, causation, and aggravation. 6. Issue a SOC pertaining to the issue of entitlement to an effective date earlier than September 11, 2014, for the grant of service connection for tinnitus in response to a timely February 2, 2015 NOD to the January 2015 rating decision. This claim will not be certified to the Board unless the Veteran perfects an appeal by filing a timely substantive appeal. MICHELLE KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel