Citation Nr: 18159503 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-62 430 DATE: December 20, 2018 ORDER Entitlement to service connection for depression is granted. Entitlement to service connection for diabetes mellitus, Type II (DM), is denied. Entitlement to service connection for high blood pressure/hypertension is denied. Entitlement to service connection for pancreatitis is denied. Entitlement to an initial compensable disability evaluation for bilateral hearing loss is denied. Entitlement to an initial disability evaluation in excess of 10 percent for tinnitus is denied. Entitlement to an effective date earlier than November 6, 2013, for the grant of service connection for bilateral hearing loss is denied. Entitlement to an effective date earlier than November 6, 2013, for the grant of service connection for tinnitus is denied. REMANDED Entitlement to service connection for a skin disorder is remanded. FINDINGS OF FACT 1. The Veteran currently has depression etiologically related to his service-connected hearing loss and tinnitus. 2. Diabetes mellitus, type II, was not manifest in service, within one year of separation from service, and is not otherwise related to the Veteran's active service. 3. Hypertension was not manifest in service, within one year of separation from service, and is not otherwise related to the Veteran's active service. 4. Pancreatitis was not manifest in service and is not otherwise related to the Veteran's active service. 5. The Veteran has been shown to have no worse than level I hearing loss in either ear. 6. Throughout the appeal period, the Veteran's bilateral tinnitus has been assigned a 10 percent rating, the maximum authorized under Diagnostic Code 6260. 7. The Veteran's initial claim for entitlement to service connection for bilateral hearing loss was received on November 6, 2014, on VA Form 21-526ez; no communication received prior to November 6, 2014, can be reasonably construed as a claim, formal or informal, for this disability. 8. The Veteran's initial claim for entitlement to service connection for tinnitus was received on November 6, 2014, on VA Form 21-526ez; there was no communication received prior to November 6, 2014 which can be reasonably construed as a claim, formal or informal, for this disability prior to this time. CONCLUSIONS OF LAW 1. The criteria for service connection for depression are met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 2. DM was not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 3. Hypertension was not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 4. Pancreatitis was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 5. The criteria for a compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.85, 4.86, Diagnostic Code (DC) 6100 (2017). 6. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for bilateral tinnitus. 38 U.S.C. § 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. § 4.87, DC 6260 (2017). 7. The criteria for an effective date earlier than November 6, 2013, for the grant of service connection for bilateral hearing loss have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). 8. The criteria for an effective date earlier than April 8, 2014, for the grant of service connection for tinnitus have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from May 1966 to May 1968. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309(a). Certain diseases, to include diabetes mellitus and hypertension, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Alternatively, a "veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C. § 1116(f) (2012); 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). Such diseases include, among others, Type 2 diabetes. 38 C.F.R. § 3.309(e). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). To establish secondary service connection, the law states that there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between a service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. A review of the Veteran’s service personnel records does not reveal any service in Vietnam. Moreover, the Veteran has not contended that he had service in Vietnam. Psychiatric Disorder, to Include Depression The Veteran maintains that he currently has depression which is etiologically related to his service-connected depression. The Board notes that while the RO initially addressed the issue of service connection for PTSD, the Veteran, through his attorney, has indicated that his current depression, claimed as PTSD, is caused by his service-connected hearing loss and tinnitus. Given the above, the Board has expanded the issue of service connection to include depression. A review of the Veteran’s service treatment records reveals no complaints or findings of any psychiatric disorders or problems in service. At the time of the Veteran’s April 1968 service separation examination, normal psychiatric findings were reported. On his April 1968 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or had ever had depression or excessive worry; nervous trouble of any sort; frequent or terrifying nightmares; or frequent trouble sleeping. There were also no complaints or findings of psychiatric problems in the years immediately following service. In support of his claim., the Veteran, through his attorney, submitted an August 2016 report from H. G, Ph.D., who indicated that following an interview of the Veteran and a review of the claims file, that it was her opinion that the Veteran’s tinnitus and hearing loss were more likely than not causing his depressive disorder. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence is against the conclusion that the Veteran's current depressive disorder had its onset in service. The Veteran's service treatment records contain no complaints or findings of psychiatric problems. Normal psychiatric findings were reported at the time of the Veteran's service separation examination, and there was no notation of psychiatric difficulties until many years following service. As to any reports that the Veteran has had psychiatric problems since service, the Board finds that the contemporaneous evidence shows that the normal psychiatric findings were reported on his service separation examination. Moreover, on his April 1968 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or had ever had depression or excessive worry; nervous trouble of any sort; frequent or terrifying nightmares; or frequent trouble sleeping. Depression was first reported many years subsequent to the Veteran's period of service. This contemporaneous evidence outweighs and is more probative than are his assertions voiced years later and in connection with a claim for disability benefits. For these reasons, the Board concludes that any assertions of depression in service and since service are not credible. As to any belief that the current psychiatric disorder is related to his period of service, the question of causation of a complex medical condition, such as sleep apnea, extends beyond an immediately observable cause-and-effect relationship, and, as such, the Veteran is not competent to address etiology in the present case. It has not been shown that he has the requisite training to diagnose the cause of his current depressive disorder. Next, service connection may be granted when the evidence establishes a nexus between active duty service and current complaints. The Veteran was afforded the opportunity to provide medical evidence and/or an opinion relating his current depression to his period of service. He has not provided either medical evidence or an opinion to support this proposition. In this case, the Veteran's depressive disorder was not shown during active service or for many years thereafter. The weight of the competent evidence demonstrates that the currently diagnosed depressive disorder was neither incurred in nor related to active service. As to the issue of secondary service connection, given the finding of depressive disorder and the medical nexus between the Veteran's service-connected bilateral hearing loss and tinnitus and his depressive disorder, service connection is warranted on a secondary basis. Resolving reasonable doubt in favor of the Veteran, service connection for depressive disorder on a secondary basis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. High Blood Pressure/Hypertension The Board finds that the weight of the evidence shows that no vascular injury or disease occurred during service, and no chronic symptoms of hypertension were manifested during service. The service treatment records show no complaint of, diagnosis of, or treatment for a vascular injury or high blood pressure. During the April 1968 discharge medical examination, the vascular system was clinically evaluated as normal, and the blood pressure reading was within normal limits (i.e., 112/60). The service treatment records, which are complete, show no vascular injury, vascular disease, or symptoms of hypertension during service. Such conditions would have ordinarily been recorded during service because the vascular system was evaluated during service. The Board finds that the weight of the evidence demonstrates that there were no "chronic" symptoms of hypertension during service. The Board next finds that the weight of the evidence is against a finding that symptoms of hypertension were continuously manifested since service, including to a degree of ten percent disabling within one year of service separation. See 38 C.F.R. § 4.104, Diagnostic Code 7101. The earliest evidence of a hypertension diagnosis reflected in the evidence of record is shown in 2007, approximately thirty nine years after service separation. The absence of post-service findings of, diagnosis of, or treatment for hypertension for thirty nine years after service separation is one factor that tends to weigh against a finding of hypertension in service or continuous symptoms after service separation, including to a compensable degree within the first post-service year. See Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). Insomuch as the Veteran has attempted to establish a continuity of symptomatology or nexus through his own lay assertions, the Board finds that the etiology of hypertension falls outside the realm of common knowledge of a layperson and the Veteran is, thus, not competent to provide evidence on the issue of causation. See Jandreau, 492 F.3d 1372, 1377 n.4. Opinions as to causation involve making findings based on medical knowledge and clinical testing results, and the cardiovascular system is complex and involves unseen systems processes and disease processes that are not observable by the five senses of a lay person. Although the Veteran is competent to report having had high blood pressure readings at any given time, he has not been shown competent to identify latent symptoms of hypertension, or relate symptoms, patent or latent, to a diagnosis of hypertension. The evidence does not show clinical documentation of hypertension until many years after service. Consequently, the Veteran's opinion that purports to establish continuity of symptomatology or relate hypertension to active service is of no probative value. Next, service connection may be granted when the evidence establishes a medical nexus between a claimed disability and service. In the current case, the Veteran has not submitted competent or probative medical evidence specifically indicating that his current hypertension is related to his to his period of service. Because the record does not show vascular injury, vascular disease, or chronic symptoms of hypertension in service, continuous symptoms of hypertension since service, hypertension manifested to a compensable degree within one year of service separation, or hypertension otherwise related to service, direct and presumptive service connection for hypertension may not be established. 38 C.F.R. §§ 3.303, 3.307, 3.309. Given the foregoing, the claim for service connection for hypertension on a direct and presumptive basis must be denied. As the weight of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DM A review of the Veteran's service treatment records reveals no complaints, findings, or diagnoses of DM. At the time of his April 1968 service separation examination, negative findings were again reported for albumin and sugar, with no notations of DM being made or reported at that time. There were also no complaints, findings, or diagnoses of DM in the years immediately following service. The record does not contain any diagnoses of DM prior to the 2000's. Therefore, the Board finds that the weight of the evidence does not demonstrate continuity of symptomatology of DM. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is not credible. As noted above, the Veteran did not report having DM in service, with negative albumin and sugar findings being reported at the time of the April 1968 service separation examination. Moreover, DM was not first diagnosed until the 2000s. The above contemporaneous evidence is more probative than his recent assertions that his current DM had its onset in service, voiced many years after service and in connection with a claim for disability benefits. See Curry, 7. Vet. App. at 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). Moreover, treatment records which have been associated with the claims folder make no reference to any findings of DM until decades following service. See Maxson v. Gober, supra. For the above reasons, continuity has not here been established, either through the clinical record or through the Veteran's own statements. As to the Veteran's belief that his current DM problems are related to his period of service, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, supra, as to the specific issue in this case, the date of onset of the Veteran's DM, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, supra. Consequently, his statements are not probative. The Veteran has not been shown to have the requisite medical expertise to render a competent medical opinion regarding DM. The question of causation extends beyond an immediately observable cause-and-effect relationship and, as such, the Veteran is not competent to address etiology in the present case. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. The Veteran was afforded the opportunity to submit such evidence and has not done so. In this case, there is no competent medical evidence of record relating any current DM to the Veteran's period of service. The Veteran is not competent to provide a medical opinion regarding etiology of any currently diagnosed DM. See Jandreau. In sum, the preponderance of the evidence weighs against a finding that any current DM is related to the Veteran's period of service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56. Pancreatitis A review of the Veteran's service treatment records reveals no complaints, findings, or diagnoses of pancreatitis. At the time of the Veteran’s April 1968 service separation examination, normal findings were reported for the stomach and viscera. On his April 1968 service separation report of medical history, the Veteran checked the “no” box when asked if he had or had ever had stomach, liver or intestinal trouble. There were also no complaints, findings, or diagnoses of pancreatitis in the years immediately following service. The record does not contain any diagnoses of pancreatitis prior to the 2000's. Therefore, the Board finds that the weight of the evidence does not demonstrate continuity of symptomatology of pancreatitis. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is not credible. As noted above, the Veteran did not report having pancreatitis in service, with normal findings for the abdomen and viscera at the time of the April 1968 service separation examination. Moreover, pancreatitis was not first diagnosed until the 2000s. The above contemporaneous evidence is more probative than his recent assertions that his current pancreatitis its onset in service, voiced many years after service and in connection with a claim for disability benefits. See Curry, 7. Vet. App. at 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). Furthermore, treatment records which have been associated with the claims folder make no reference to any findings of pancreatitis until decades following service. See Maxson v. Gober, supra. For the above reasons, continuity has not here been established, either through the clinical record or through the Veteran's own statements. As to the Veteran's belief that his current pancreatitis problems are related to his period of service, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, supra, as to the specific issue in this case, the date of onset of the Veteran's pancreatitis falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, supra. Consequently, his statements are not probative. The Veteran has not been shown to have the requisite medical expertise to render a competent medical opinion regarding pancreatitis. The question of causation extends beyond an immediately observable cause-and-effect relationship and, as such, the Veteran is not competent to address etiology in the present case. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, there is also no competent medical evidence of record relating any current pancreatitis to the Veteran's period of service. The Veteran was afforded the opportunity to submit such evidence and has not done so. The Veteran is not competent to provide a medical opinion regarding etiology of any currently diagnosed pancreatitis. See Jandreau. In sum, the preponderance of the evidence weighs against a finding that any current pancreatitis is related to the Veteran's period of service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56. Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Hearing Loss The Veteran has been assigned a noncompensable evaluation under Diagnostic Code 6100 for his service-connected bilateral hearing loss. He contends that the severity of his condition more closely reflects the severity required for a higher disability rating. The VA rating scheme for the evaluation of hearing loss provides ratings from noncompensable to 100 percent based on the results of controlled speech discrimination tests together with the results of puretone audiometry tests which average puretone thresholds at 1000, 2000, 3000 and 4000 Hertz. 38 C.F.R. § 4.85 (2017). The evaluation of hearing impairment applies a formula which is essentially a mechanical application of the VA Schedule for Rating Disabilities to numeric designations after audiology evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85(a) (2017). Using Table VI in 38 C.F.R. § 4.85, the puretone average and speech recognition score are combined to give each ear a numeric designation for use on Table VII to determine the correct disability level. Alternatively, Table VIA uses only the puretone averages to give each ear a numeric designation. The regulations have two provisions for evaluating veterans with certain patterns of hearing impairment that cannot always be accurately assessed under § 4.85 because the speech discrimination test may not reflect the severity of communicative functioning that veterans experience. 38 C.F.R. § 4.86(a) provides that if puretone thresholds in the specified frequencies of 1000, 2000, 3000, and 4000 Hertz are each 55 decibels or more, an evaluation can be based either on Table VI or Table VIA, whichever results in a higher evaluation. This provision corrects the fact that with a 55-decibel threshold level (the level at which speech becomes essentially inaudible) the high level of amplification needed to attempt to conduct a speech discrimination test would be painful to most people, and speech discrimination tests may therefore not be possible or reliable. See 64 Fed. Reg. 25209 (May 11, 1999). Additionally, 38 C.F.R. § 4.86(b) provides that if the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, an evaluation can be based on either Table VI or Table VIA, whichever results in a higher numeric designation, and that designation will then be elevated to the next higher Roman numeral. This provision compensates for a pattern of hearing impairment that is an extreme handicap in the presence of any environmental noise, and a speech discrimination test conducted in a quiet room with amplification of sound does not always reflect the extent of impairment experienced in the ordinary environment. The Veteran has not been shown to have either of these exceptional patterns at any time. The Veteran has argued that his hearing loss is more severe than is reflected by his assigned evaluations. He has reported that he cannot hear his wife, the television, or conversations. Although the Veteran is competent to attest to his observations and laypeople may, in some circumstances, opine on questions of diagnosis and etiology, in this case, the Veteran is not competent to diagnose himself with a particular level of hearing impairment. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also 38 C.F.R. § 3.159(a)(1) (2017) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Specifically, while the Veteran is clearly competent to describe what he experiences (diminished hearing), he is unable to provide competent evidence as the audiometry or measured level of his hearing loss to support a higher disability rating. In conjunction with his claim, the Veteran was afforded a VA examination in March 2015. At the time of the examination, the Veteran reported that his hearing loss was getting worse. Audiological evaluation revealed pure tone thresholds, in decibels, as follows: right ear 20, 25, 35, and 80, and left ear 35, 45, 55, and 65, at 1000, 2000, 3000, and 4000 Hertz, respectively. Speech audiometry testing revealed speech recognition ability of 92 percent in the right ear and of 92 percent in the left ear. The examiner rendered diagnoses of bilateral sensorineural hearing loss. Using Table VI in 38 C.F.R. § 4.85, the Veteran's right ear corresponded with Level I hearing loss, the left ear corresponded with Level I hearing loss. These levels correspond with a noncompensable evaluation. In sum, hearing was, at worst, level I in the right ear and level I in the left ear. A comparison between these hearing levels and 38 C.F.R. § 4.85, Table VII, yields a noncompensable evaluation, consistent with the currently assigned rating. Tinnitus The Veteran is seeking an increased rating for bilateral tinnitus. Diagnostic Code 6260 provides a maximum rating of 10 percent for recurrent tinnitus. In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the United States Court of Appeals for the Federal Circuit found that 38 C.F.R. § 4.25(b) and 38 C.F.R. § 4.87, Diagnostic Code 6260, limits a veteran to a single disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Veteran's service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus of 10 percent. 38 C.F.R. § 4.87, Diagnostic Code 6260. As there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear, the Veteran's appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). Effective Date If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400(b)(2). Otherwise, the effective date of an award based on an original claim or a claim reopened after final adjudication shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400; Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999). Public Law 115-154, Section 506, amended 38 U.S.C. § 5110 to allow up to a one-year retroactive effective date award of disability compensation based on fully developed original claims for compensation that VA received from August 6, 2013, through August 5, 2015. Under the Fully Developed Claim (FDC) framework, a claim is submitted in a "fully developed" status, limiting the need for further development of the claim by VA. When filing a fully developed claim, a veteran is to submit all evidence relevant and pertinent to his claim other than service treatment records and treatment records from VA medical centers. Under certain circumstances, additional development may still be required prior to the adjudication of the claim, such as obtaining Federal records and providing a VA medical examination to the veteran. See VA Form 21-526EZ. The Veteran filed his initial claim for service connection using the 21-526ez form on November 6, 2014. There was no correspondence prior to this time. Importantly, the pertinent regulations specifically state that the effective date should be the date of a claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. The Veteran’s claim was assigned an effective date of November 6, 2013, one year before the date of his initial claim. As noted above, Public Law 115-154, Section 506, amended 38 U.S.C. § 5110 to allow up to a one-year retroactive effective date award of disability compensation based on fully developed original claims for compensation that VA received from August 6, 2013, through August 5, 2015. While sympathetic to the Veteran's belief that an earlier effective date is warranted, for the reasons outlined above, the Board is precluded by law from assigning an effective date prior to November 6, 2013, for the grant of service connection for bilateral hearing loss and tinnitus. Accordingly, the preponderance of the evidence is against the claim for effective dates prior November 6, 2013, for the awards of service connection for bilateral hearing loss and tinnitus. As such, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). REASONS FOR REMAND As it relates to the claim of service connection for a skin disorder, the Board notes that the Veteran was seen with complaints of skin problems on several occasions during service. The Veteran has subsequently been diagnosed with several skin disorders following service, to include seborrheic keratosis and more recently squamous cell carcinoma. Given the above, the Veteran should be afforded a VA skin examination to determine the etiology of any current skin disorder and its relationship, if any, to his period of service. The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a VA dermatology examination by an appropriate examiner to determine the current nature and etiology of the Veteran's skin disorder. The entire record must be made available to and reviewed by the examiner in connection with the examination. The examination report is to contain a notation that the examiner reviewed the claims file, to include the Veteran's service records. The examiner is requested to render an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current skin disorder is related to the Veteran’s period of service. (Continued on the next page)   Complete detailed rationale is required for each opinion that is rendered. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. S. Kelly, Counsel