Citation Nr: 18159819 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 16-29 485 DATE: December 20, 2018 ORDER Service connection for a left foot disability is denied. Service connection for a right foot disability is denied. Service connection for Meniere's disease, claimed as vertigo, is denied. Service connection for hypertension is denied. Service connection for thrombocytopenia is denied. Service connection for tinea versicolor is granted. Service connection for residuals of a traumatic brain injury (TBI), to include loss of sense of smell, is denied. An initial evaluation of 30 percent, but not in excess thereof, for the period prior to August 13, 2012, for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is granted, subject to the laws and regulations governing the payment of VA benefits. An evaluation in excess of 30 percent, for the period from August 13, 2012, for an acquired psychiatric disability, to include PTSD, is denied. An effective date of June 18, 2012, for an award of service connection for tinnitus is granted. An initial evaluation in excess of 10 percent for tinnitus is denied. An initial evaluation in excess of 10 percent for peripheral neuropathy of the left lower extremity is denied. An initial evaluation in excess of 10 percent for peripheral neuropathy of the right lower extremity is denied. FINDINGS OF FACT 1. A left foot disability is not related to service or to a service-connected disability. 2. A right foot disability is not related to service or to a service-connected disability. 3. The Veteran does not have a current disability of vertigo or Meniere’s disease. 4. Hypertension is not related to service, did not manifest within one year of separation from service, and is not related to a service-connected disability. 5. Thrombocytopenia is not related to service. 6. Tinea versicolor arose in service. 7. The Veteran does not have current residuals of a TBI. 8. For the period on appeal prior to August 13, 2012, the Veteran’s acquired psychiatric disability was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). 9. For the entirety of the appeal period, the Veteran’s acquired psychiatric disability was not productive of occupational and social impairment with reduced reliability and productivity, of occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, or of total occupational and social impairment. 10. The Veteran’s claim of service connection for tinnitus was received by VA on June 18, 2012. 11. The Veteran’s tinnitus is productive of no more than typical tinnitus. 12. The Veteran’s peripheral neuropathy of the left lower extremity is not productive of the equivalent of moderate incomplete paralysis, severe incomplete paralysis, or complete paralysis of the external popliteal nerve. 13. The Veteran’s peripheral neuropathy of the right lower extremity is not productive of the equivalent of moderate incomplete paralysis, severe incomplete paralysis, or complete paralysis of the external popliteal nerve. CONCLUSIONS OF LAW 1. The criteria for service connection for a left foot disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 2. The criteria for service connection for a right foot disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 3. The criteria for service connection for Meniere’s disease, claimed as vertigo, have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 4. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 5. The criteria for service connection for thrombocytopenia have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 6. The criteria for service connection for tinea versicolor have been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 7. The criteria for service connection for residuals of a TBI have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 8. The criteria for an initial evaluation of 30 percent, but not in excess thereof, for an acquired psychiatric disability, for the period prior to August 13, 2012, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). 9. The criteria for an evaluation in excess of 30 percent for an acquired psychiatric disability, to include PTSD, for the period from August 13, 2012, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017) 10. The criteria for an effective date of June 18, 2012, for an award of service connection for tinnitus have been met. 38 U.S.C.A §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.400 (2017). 11. The criteria for an initial evaluation in excess of 10 percent for tinnitus have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87, Diagnostic Code 6260 (2017). 12. The criteria for an initial evaluation in excess of 10 percent for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.124a, Diagnostic Code 8521 (2017). 13. The criteria for an initial evaluation in excess of 10 percent for peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.124a, Diagnostic Code 8521 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1969 to June 1971. This appeal is before the Board of Veterans’ Appeals (Board) from a November 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota, and from February 2013 and May 2013 rating decisions of the RO in Baltimore, Maryland. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). In the case of a veteran who engaged in combat with the enemy in a period of war, lay evidence of in-service incurrence or aggravation of a disease or injury shall be accepted if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the lack of official record of such incurrence or aggravation. The incurrence or aggravation may be rebutted by clear and convincing evidence to the contrary. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d); Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Collette v. Brown, 82 F.3d 389, 392-94 (Fed. Cir. 1996). The standard used to determine whether a veteran engaged in combat with the enemy is reasonable doubt, which is to be resolved in a veteran’s favor. See VAOPGCPREC 12-99. The provisions of 38 U.S.C. § 1154(b), however, can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to a current disorder. See Libertine, 9 Vet. App. at 522-23. The provisions of 38 U.S.C. § 1154(b) do not establish service connection for a combat veteran; it aids him by relaxing the adjudicative evidentiary requirements for determining what happened in service. Clyburn v. West, 12 Vet. App. 296, 303 (1999). For certain chronic diseases, such as arthritis and hypertension, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For certain diseases with a relationship to herbicide agent exposure, a presumption of service connection arises if the disease manifests to a degree of 10 percent or more following service in the Republic of Vietnam any time during the period from January 9, 1962 to May 7, 1975. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). Absent such a presumption, a veteran may establish service connection on a direct basis if the evidence shows that a current disability was, in fact, caused by exposure to herbicide agents or some other incident of service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 1. Entitlement to service connection for a left foot disability 2. Entitlement to service connection for a right foot disability The Veteran claims service connection for disabilities of the bilateral feet. Service treatment records do not reflect any symptoms of or treatment for any disabilities of the feet. No such abnormalities were noted at the Veteran’s April 1971 separation examination. VA treatment records reflect that in April 2012 the Veteran reported bilateral foot pain for the prior couple of months, mostly on the sole of the foot, worse with ambulating, and worse on the right. His physician noted that examination was benign and his diabetes was very well controlled, so it was suspected that this may be a neuroma and not neuropathy. At a May 2012 podiatry consultation he was diagnosed with bilateral pronation and mild plantar fasciitis. He reported improvement in June 2012. In his June 2012 claim, the Veteran reported foot conditions both directly connected to service and secondary to diabetes. He reported extreme pain in his feet when walking. He stated that his physician instructed him to get inserts. In his June 2013 notice of disagreement, the Veteran through his representative argued that his foot disabilities are secondary to his service-connected diabetes mellitus and/or peripheral neuropathy. The Board finds that the evidence weighs against a finding that any foot disability is related to service or to a service-connected disability, except for peripheral neuropathy already service-connected. The only diagnosis of a foot disability beyond peripheral neuropathy is his May 2012 diagnosis of pronation and plantar fasciitis. To the extent that the Veteran claims direct service connection, he has identified no event, disease, or injury in service to which he believes these conditions are related. Service treatment records likewise do not provide any in-service event, disease, or injury. To the extent that he claims secondary service connection, there is no medical evidence in the record indicating a relationship between diabetes mellitus and pronation or plantar fasciitis. The Veteran has provided no basis of knowledge for his belief that they may be related. For these reasons, the Board finds that the evidence weighs against a finding that any foot disability is related to service or to a service-connected disability, except for peripheral neuropathy already service-connected. Service connection is therefore denied. 3. Entitlement to service connection for Meniere's disease, claimed as vertigo The Veteran claims service connection for vertigo. Service treatment records do not reflect any symptoms of or treatment for vertigo or Meniere’s disease. No such abnormalities were noted at the Veteran’s April 1971 separation examination. Private treatment records reflect that in March 1991 the Veteran reported problems with dizziness. His physician noted lowered blood pressure and altered his hypertension medication. In August 1992 he reported an acute onset of dizzy spells. He reported that this was the second time this had occurred, the first being a year and a half prior. He was diagnosed with an acute vertiginous episode. In January 1993 he reported a severe episode that began on New Year’s Eve. He was diagnosed with severe vertigo, probably secondary to sinusitis with a eustachian tube dysfunction. In his July 2012 claim, the Veteran reported dizziness and balance problems, and stated that he had been evaluated for Meniere’s disease in the past. The Veteran underwent a VA examination in August 2012. He reported having suffered a TBI in service in 1970, and that in 1993 he developed dizziness, nausea, and occasional vomiting with on and off symptoms until 2000. (The report initially states that the symptoms resolved in 2010, but then twice states that they resolved in 2000. The year 2000 is consistent with his reports in his TBI examination.) The examiner found that the only current symptom of a vestibular condition that the Veteran reported was tinnitus. Physical examination was normal for his external ear, ear canal, tympanic membrane, gait, Romberg test, Dix Hallpike test, and limb coordination test. There were no findings of Meniere’s disease or vertigo. The examiner opined that the Veteran’s reported dizziness symptoms were less likely than not related to his reported TBI. This opinion was based on the rationale that there was an approximate 23-year gap between the Veteran’s reported TBI and dizziness, which had since resolved and had not recurred. In his October 2012 notice of disagreement, the Veteran through his representative reported constant ear infections. He stated that his balance is not what it used to be and that he is wobbly when getting up to use the restroom. He stated that he does not suffer from constant vertigo but that there had been times where he had been so dizzy that it made him sick. He further requested that his claim be liberally construed so as to include possible lesser claims such as otitis media. VA treatment records reflect that in January 2014 the Veteran reported that he had three ear infections in the prior year. He stated that he believed this was due to a medication change. The Board finds that the evidence weighs against a finding of a current disability of vertigo or Meniere’s disease. Treatment records along with the Veteran’s statements do not indicate the presence of any such symptoms after 2010, as his claim was not filed until July 2012. His August 2012 VA examination showed no current symptoms. Furthermore, the Board is unsure how otitis media can be considered a “lesser included” claim to vertigo when the Veteran does not report current vertigo. (In any event, there is no indication in the record that any current ear infections are related to service.) Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, the Board finds that the evidence weighs against a finding of a current disability and service connection must therefore be denied. 4. Entitlement to service connection for hypertension The Veteran claims service connection for hypertension. VA regulations require that hypertension or isolated systolic hypertension be confirmed by readings taken two or more times on at least three different days. For compensation purposes, hypertension means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101. Service treatment records do not reflect any symptoms of or treatment for hypertension. No such abnormality was noted at the Veteran’s April 1971 separation examination, where his blood pressure was measured at 130/70. Private treatment records reflect that in December 1990 the Veteran was treated for hypertension. His physician noted that hypertension was first diagnosed 8 years prior. Records reflect routine hypertension treatment and monitoring thereafter. In January 2008 he was noted to have longstanding hypertension. He reported that he had hypertension for approximately 30 years. At a May 2009 follow-up noted that his blood pressure readings were primarily under control with medication. His diagnosis was benign essential hypertension. In March 2011, the Veteran informed VA that he believed his hypertension was secondary to his diabetes mellitus, for which service connection was subsequently granted. The Veteran underwent a VA examination in March 2011. The examiner noted that hypertension was diagnosed in 1980. Blood pressure was measured at 150/90, and he was noted to be on daily medication. He was diagnosed with current hypertension. In a March 2011 statement, the Veteran reported that he was initially treated for hypertension in 1981. VA treatment records reflect that in July 2011 the Veteran’s physician noted that his hypertension was only marginally controlled. Blood pressure was measured at 141/84 and 144/84. In February 2012 his physician noted that his hypertension was not optimally controlled. Blood pressure was measured at 143/84, 138/88, and 141/84. In an August 2012 VA medical opinion based on a review of the claims file, a VA examiner opined that hypertension was less likely than not related to the Veteran’s service-connected diabetes mellitus. This opinion was based on the rationale that hypertension was diagnosed in 1980, 28 years before his diagnosis of diabetes mellitus in 2008. The examiner further noted that there was no indication of hypertension in service or within one year of separation. In his October 2012 notice of disagreement, the Veteran through his representative argued that his hypertension could be associated with his PTSD. He reported that he has experienced his PTSD symptoms since his discharge. He further requested the benefit of the doubt that his hypertension had existed but went undiagnosed at discharge or within one year of his discharge. VA treatment records reflect that in January 2014 the Veteran’s hypertension was under optimal control. The Veteran underwent another VA examination in March 2016. Blood pressure was measured at 128/74, 130/76, and 126/76. The examiner inexplicably noted a history of hypertension since only 2010. Nevertheless, the examiner opined that hypertension was less likely than not aggravated beyond its natural progression by diabetes mellitus. This opinion was based on the rationale that there was no indication of mitigating heart or kidney disease with which one could clearly establish aggravation of this “prior known existing” condition. The Board finds that the evidence weighs against a finding that hypertension is related to service, manifested within one year of separation from service, or is related to a service-connected disability. As to direct service connection, there is no indication that hypertension arose in service or is otherwise directly related to service. There is likewise no indication that hypertension manifested within one year of separation. In his October 2012 notice of disagreement, the Veteran through his representative requested that the Board presume that hypertension arose in service or within one year of separation based solely on the benefit of the doubt doctrine. Such would not be an appropriate use of the doctrine. The Veteran has offered no evidence that hypertension arose so early beyond pure speculation, and service treatment records clearly show normal blood pressure at his April 1971 separation examination. As to secondary service connection, the VA examiners gave credible opinions explaining why hypertension was neither caused nor aggravated by the Veteran’s diabetes mellitus. Hypertension predated diabetes by several decades, and there was no indication of mitigating heart or kidney disease to show aggravation. The Board recognizes that the March 2016 VA examiner erred in stating that hypertension was first diagnosed in 2010. The examiner’s opinion regarding aggravation, however, is still adequate, as the rationale was unrelated to the date of diagnosis. As to PTSD, there is no indication in the record that PTSD caused or aggravated the Veteran’s hypertension beyond the pure speculation in the October 2012 notice of disagreement. While the Veteran alleges PTSD symptoms since separation, he was not diagnosed until 2010, despite being married to the director of inpatient psychology at a local hospital (as reported in his August 2012 PTSD VA examination). There is no indication of any compensable worsening of hypertension in this century, as the Veteran has remained on medication and diastolic pressure has not been reported at or above 110 and systolic pressure has not been reported at or above 200. For these reasons, the Board finds that the evidence weighs against a finding that hypertension is related to service, manifested within one year of separation from service, or is related to a service-connected disability. Service connection is therefore denied. 5. Entitlement to service connection for thrombocytopenia The Veteran claims service connection for thrombocytopenia. Service treatment records do not reflect any symptoms of or treatment for thrombocytopenia. No such abnormality was noted at the Veteran’s April 1971 separation examination. Private treatment records include a June 2010 consultation report from the Veteran’s hematologist noting that he was initially diagnosed with thrombocytopenia in August 2009 and was also noted to have mild splenomegaly in a September 2009 ultrasound. A blood smear showed no evidence to suggest a primary bone marrow disorder, and splenomegaly was not appreciated on physical examination. Given the Veteran’s age and exposure to herbicide agents, the hematologist recommended a bone marrow biopsy to rule out any underlying disorders. A July 2010 biopsy report showed mildly hypercellular marrow with trilineage hematopoiesis, a mild relative increase in the erythroid lineage, no increase in blasts, no increase in lymphocytes or plasma cells, and no ringed sideroblasts. In his July 2010 informal claim, the Veteran reported that his platelet count had been running mildly low at 115,000. He stated that preliminary results of a recent bone marry biopsy showed that it was not leukemia, but his hematologist wanted to proceed with biopsies because he was exposed to Agent Orange. In his October 2010 claim, he reported that his thrombocytopenia began in August 2008. VA treatment records reflect that in February 2012 the Veteran’s treating physician noted that his thrombocytopenia was stable. In January 2014 he reported that it was stable. In January 2015 he reported that a private biopsy showed no cancer or malignant condition and his platelet count had remained stable. The Board finds that the evidence weighs against a finding that thrombocytopenia is related to service. Service treatment records do not show any signs of this disability, and the Veteran’s claim indicates that it arose in August 2008. Neither the Veteran’s statements nor his treatment records give any explanation for how this disability could be related to service. For these reasons, the Board finds that the evidence weighs against a finding that thrombocytopenia is related to service, and service connection is therefore denied. 6. Entitlement to service connection for tinea versicolor The Veteran claims service connection for tinea versicolor. Service treatment records do not reflect any symptoms of or treatment for any disabilities of the skin. No such abnormalities were noted at the Veteran’s April 1971 separation examination. Private treatment records reflect that in February 1991 the Veteran reported having had trouble with tinea versicolor since Vietnam. He was diagnosed with tinea versicolor. In his October 2012 claim, the Veteran reported that he has had tinea versicolor since serving in Vietnam. He stated that he had been referred to a dermatologist or two over the years who prescribed salves and shampoos which worked for a while, but each spring his tinea versicolor returned. He provided a photograph showing current discoloration on his back. In his June 2013 notice of disagreement, the Veteran through his representative cited medical literature indicating that tinea versicolor most commonly has onset in adolescent boys and young adult men, and that it typically occurs in hot climates. VA treatment records reflect that in January 2014 the Veteran was diagnosed with xerosis of the feet and was recommended soaking and foot cream. There was no mention of tinea versicolor. The Board finds that the evidence is at least in equipoise as to whether tinea versicolor arose in service. Such a disability is minor enough that it is credible that the Veteran would not necessarily report it in service, nor would it necessarily be noted at his separation examination. His report in February 1991 that he had the condition since Vietnam is highly probative. Given that he did not seek service connection for the disability until more than 20 years later, it did not benefit him in any way at the time to offer this information, supporting its credibility. There is nothing in the record to contradict this report. Furthermore, the photograph provided with his claim shows that the disability is still current. For these reasons, the Board finds that the evidence is at least in equipoise as to whether tinea versicolor arose in service. Service connection is therefore granted. 7. Entitlement to service connection for a TBI, to include loss of sense of smell The Veteran claims service connection for TBI residuals. Service treatment records do not reflect any symptoms of or treatment for any head injuries. No such abnormalities were noted at the Veteran’s April 1971 separation examination. In his July 2012 claim, the Veteran reported that while serving in Vietnam, someone fired an M-16 within one inch of his ear, causing him to lose consciousness. He did not know how long he was knocked out, but he awoke in severe pain. He reported that he was treated at VA for symptoms of a head injury in the time frame of 1971-1972. In an August 10, 2012 statement, he added that he lost his sense of smell 27 years after experiencing this trauma. He reported that he was unsure if this was related to the trauma. The Veteran underwent a VA examination on August 13, 2012. He reported that he suffered a head injury in around 1970. Specifically, he reported that the muzzle of an M-16 fired a bullet off about 1-2 inches form his right ear, causing him to lose consciousness. He next recalled being in a bunker 8-48 hours later. He reported that he did not seek medical treatment, but had right ear pain and tinnitus. The pain resolved but the tinnitus persisted. He reported 5-6 episodes of vertigo lasting 2-3 days each in the 1990s but none since. He was told it was not Meniere’s disease. Currently, he reported mild memory loss, specifically a difficulty remembering the names of colleagues for several years. Judgment was normal and social interaction was routinely appropriate. Orientation, motor activity, and visual spatial orientation were normal. There were no subjective symptoms, including alteration of smell. There were no neurobehavioral effects. Communication and consciousness were normal. The examiner opined that dizziness and vertigo in the 1990s and again in 2010 were less likely than not related to his reported TBI. The examiner noted that there was no evidence in the claims file to support the Veteran’s report of a TBI in service. The examiner further explained that it would be highly unusual for a TBI to result in dizziness and/or vertigo with onset over 20 years after the incident. Typically, a TBI will either include such symptoms immediately after the injury with gradual improvement thereafter, or cause vertigo within weeks (not years) of the incident in the form of benign paroxysmal positional vertigo. In his June 2013 notice of disagreement, the Veteran through his representative argued that efforts must be made to obtain VA treatment records from his reported treatment after discharge in 1971-1972. In an accompanying statement the representative argued that the TBI injury was a combat injury covered under 38 C.F.R. § 3.304(d). The Board finds that the evidence weighs against a finding of current TBI residuals. While the Veteran’s reports of experiencing a combat injury are accepted as reported under 38 C.F.R. § 3.304(d), the evidence does not establish that such an injury resulted in current residuals. The only symptoms noted at the Veteran’s August 2012 VA examination were tinnitus and memory loss. He is already service-connected for tinnitus, and his memory loss has been associated with and compensated for via his service-connected PTSD. While he reported a loss of his sense of smell in an August 2012 statement, three days later he did not report it at his VA examination, and the examiner found no evidence of alteration of smell. While he also reported vertigo, he had not experienced it after 2010, well before his July 2012 claim. In any event, the August 2012 VA examiner provided a credible opinion as to why a TBI experienced in 1970 was highly unlikely to result in vertigo arising in 1991. For these reasons, the Board finds that the evidence weighs against a finding of current TBI residuals. Service connection is therefore denied. Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran’s ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. “Staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App 119 (1999). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). 8. Entitlement to an initial evaluation in excess of 10 percent, for the period prior to August 13, 2012, for an acquired psychiatric disability, to include PTSD 9. Entitlement to an evaluation in excess of 30 percent, for the period from August 13, 2012, for an acquired psychiatric disability, to include PTSD The Veteran claims increased ratings for PTSD. Diagnostic Code 9411 of 38 C.F.R. § 4.130 specifically addresses PTSD; however, all psychiatric disabilities are evaluated under a general rating formula for mental disorders. Under the general rating formula, a 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such an unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A total schedular rating of 100 percent is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Id. at 443. Furthermore, the rating code requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment at a level consistent with the assigned rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Veteran underwent a VA examination in March 2011. He reported daily symptoms of intrusive recollections, hyperarousal, irritability, and feelings of detachment. He reported severity of mild to moderate and a constant duration. He had no history of psychiatric treatment. He was working full-time and not missing any time due to his symptoms. Thought processes and communication were unaffected. Cognitive functions were mildly impaired in the area of concentration and attention. Memory was not deficient. The examiner diagnosed PTSD with depressive features causing mild-to-moderate social and occupational deficiencies. VA treatment records reflect that in March 2011 the Veteran reported that his symptoms had been more pronounced in the past, but he still had trouble with mood, irritability, numbness, inability to get close to others, and avoidance. He reported nightmares once or twice per month. He was diagnosed with chronic PTSD. He began group therapy. In December 2011 he reported that he has fleeting suicidal ideation after he argues with his wife. He denied plan or intent to harm himself. In his July 2012 notice of disagreement, the Veteran through his representative reported memory problems, such as forgetting names and to complete tasks. He reported irritability, anger issues, and overreactions. Though currently employed, he reported having 16 jobs over 40 years and attributed his frequent job changes to his memory problems. He reported difficulty with social relationships, though his family relationships were good. The Veteran underwent another VA examination on August 13, 2012. He reported being married for 39 years with three grown children and seven grandchildren and that he had difficulty feeling connected to his family. He reported that his children and grandchildren come to dinner every Sunday. He reported being emotionally disconnected and that he does not relate well to his children. He reported that he is involved with his church but has no other significant activities beyond spending time with his family and exercise, specifically using an elliptical machine and doing yoga. He reported that he was currently employed and that irritability contributed to his problems at work. He denied significant difficulties falling or staying asleep. He reported a low frustration tolerance. He reported avoidance of crowds. He reported difficulty with memory and poor motivation. Mood was good and affect was euthymic. Thought processes were logical and goal-oriented. There was no evidence or report of delusions or hallucinations. Memory and attention appeared grossly intact. Insight and judgment were fair. He denied current suicidal or homicidal ideation, but stated that he thinks about suicide passively when fighting with his wife. The examiner noted symptoms of anxiety and mild memory loss. The examiner diagnosed PTSD productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. VA treatment records reflect that in October 2012 the Veteran requested individual therapy due to continued intimacy issues related to PTSD. He appeared agitated in his presentation, using hand gestures and frequently shifting in his chair. He was noted to have severe crying symptoms, moderate symptoms of loss of interest in sex and general loss of interest, and mild symptoms of loss of pleasure, self-dislike, suicidal thoughts, loss of energy, and tiredness or fatigue. He denied nightmares. His recent memory was intact, but he had difficulty remembering important parts of his Vietnam service. He reported that he enjoys photography, reads the Bible daily, and attends church. His diagnosis of PTSD was continued. In November 2012 he reported that he struggles with energy, stating that he works hard at his job leaving him little reserve for connecting with others. He stated that this caused marital problems. A flat affect was noted. In December 2012 he reported difficulty asserting himself with his wife. He reported that he gets along well at work but has trouble communicating with doctors and when something with his wife is meaningful. He reported difficulty communicating his feelings. He reported recent difficulty sleeping due to stress. In January 2013 he reported social anxiety. In March 2013 he reported being tired and sad. In May 2013 he reported that he was somewhat anxious. He was noted to have severe symptoms of crying and tiredness or fatigue, moderate symptoms of loss of pleasure, loss of energy, loss of interest in sex, and general loss of interest, and mild symptoms of pessimism, self-dislike, and indecisiveness. In July 2013 he began couples therapy with his wife. Their social worker noted problems with communication in part due to the Veteran’s PTSD symptoms. He reported being suicidal after an argument with his wife. In September 2013 their therapist stated that the theme of their problems was the Veteran’s PTSD, mainly his emotional numbing and avoidance of feelings. The Board finds that an initial evaluation of 30 percent is warranted for the period prior to August 13, 2012. Such a rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). The Board finds that this rating is more consistent with the findings of the March 2011 VA examiner, who indicated that PTSD was productive of mild-to-moderate social and occupational deficiencies. Furthermore, neither the August 2012 VA examination nor contemporaneous treatment records indicate a worsening of PTSD, indicating that staging is not appropriate. For these reasons, the Board finds that the Veteran’s acquired psychiatric disability warrants a 30 percent rating for the period prior to August 13, 2012. The Board further finds that an evaluation in excess of 30 percent is not warranted at any point throughout the appeal period. Higher ratings are available for occupational and social impairment with reduced reliability and productivity, for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, or for total occupational and social impairment. The evidence weighs against such manifestations. Prior to his retirement, the Veteran was able to work full time without absences due to his PTSD symptoms. His symptoms present with social anxiety and perceptions of social awkwardness, but he is nevertheless able to maintain relationships. His family relationships, while strained by his symptoms, remain strong. His treatment for his symptoms has been minimal over the appeal period. Aside from his fleeting suicidal thoughts with no plan or intent, his symptoms are of the relatively mild kind contemplated by the 30 percent criteria. Specifically, he reports mild memory loss, irritability, depressed mood, and anxiety. He has not reported more serious symptoms such as panic attacks, impaired judgment, impaired impulse control, or other such symptoms associated with higher ratings. Rather, his therapist identified that his most severe symptoms are emotional lability and tiredness or fatigue. For these reasons, the Board finds that an evaluation in excess of 30 percent is not warranted at any point throughout the appeal period for the Veteran’s acquired psychiatric disability. 10. Entitlement to an effective date earlier than July 6, 2012, for an award of service connection for tinnitus 11. Entitlement to an initial evaluation in excess of 10 percent for tinnitus The Veteran claims an increased rating for tinnitus and an earlier effective date. The Veteran’s tinnitus is rated under 38 C.F.R. § 4.87, Diagnostic Code 6260. His current 10 percent rating is warranted for recurrent tinnitus and is the maximum rating available under this code. Generally, the effective date of an award of a service connection claim is the date of receipt of a claim or the date entitlement arose, whichever is later. 38 U.S.C.A § 5110(a); 38 C.F.R. § 3.400. Under regulations applicable prior to March 24, 2015, any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. An informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (2014). In a statement received by VA on June 18, 2012, the Veteran reported a constant ringing in his ears which he notices mostly when it is quiet, such as during the night. He explicitly requested VA open a claim for service connection for tinnitus. In a statement received by VA on July 6, 2012, the Veteran requested that VA please note that he had recently placed a claim for service connection for tinnitus. The Veteran underwent a VA examination in August 2012. He reported constant bilateral tinnitus. He reported that his tinnitus was bothersome. In a separate August 2012 VA examination for vertigo, he reported experiencing tinnitus more than once per week. In his October 2012 notice of disagreement, the Veteran through his representative did not argue for an increased rating for tinnitus. Rather, the argument was for an effective date of June 18, 2012, instead of the current effective date of July 6, 2012. The RO construed this as an appeal for an increased rating. As the Veteran listed the increased rating issue in his June 2016 substantive appeal, the Board will still consider this aspect of the issue. VA treatment records reflect that in July 2015 the Veteran reported constant bilateral tinnitus that causes issues when sleeping. As an initial matter, the Board grants the Veteran an effective date for service connection for tinnitus of June 18, 2012. The Veteran clearly articulated a claim for tinnitus on a statement received by VA on this date. There is no reason why the subsequent July 6 statement should be considered the date of the claim. The Board notes that the issue of an earlier effective date was not addressed in any statement of the case issued by the RO. While such circumstances would normally require a remand under Manlincon v. West, 12 Vet. App. 238 (1999), in the interest of efficiency the Board finds that it may grant the precise relief sought by the October 2012 notice of disagreement. As this is therefore a full grant, there is no prejudice to the Veteran in proceeding without a statement of the case. For these reasons, the Board grants an effective date for service connection for tinnitus of June 18, 2012. The Board further finds that a rating in excess of 10 percent is not warranted for the Veteran’s tinnitus. He is currently in receipt of the maximum schedular rating for tinnitus. He has not provided any indication why his tinnitus is atypical or otherwise warranting a rating higher than that afforded to nearly every other Veteran with service-connected tinnitus. Indeed, the record raises doubt as to whether the Veteran even intended to appeal for an increased evaluation for his tinnitus. For these reasons, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran’s tinnitus. 12. Entitlement to an initial evaluation in excess of 10 percent for peripheral neuropathy of the left lower extremity 13. Entitlement to an initial evaluation in excess of 10 percent for peripheral neuropathy of the right lower extremity The Veteran claims increased ratings for his peripheral neuropathy of his lower extremities. The Veteran is currently in receipt of a 10 percent rating for peripheral neuropathy of each of the lower extremities, manifested by paralysis of the external popliteal nerve, evaluated under 38 C.F.R. § 4.124a, Diagnostic Code 8521. An evaluation of 10 percent is warranted for mild incomplete paralysis, an evaluation of 20 percent is warranted for moderate incomplete paralysis, an evaluation of 30 percent is warranted for severe incomplete paralysis, and an evaluation of 40 percent is warranted for complete paralysis. Complete paralysis of the external popliteal nerve is productive of foot drop and slight droop of the first phalanges of all toes, inability to dorsiflex the foot, extension of proximal phalanges of toes lost, abduction of foot lost, adduction weakened, and anesthesia covering the entire dorsum of the foot and toes. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. In rating the peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. In his July 2010 informal claim, the Veteran reported that while being treated by his podiatrist he was unable to feel vibrations from a tuning fork on his ankle bones. The Veteran underwent a VA examination in March 2011. He reported that he recently cut his foot without realizing it, and that his treating podiatrist noted decreased vibratory sensation in his lower extremities. He reported flares which occur monthly with duration of a few minutes. He denied pain or weakness. He denied fatigue or functional loss. Sensory examination was normal to light touch, dull, and pinprick, but decreased to vibratory and 5.05 monofilament distally. He had normal proprioception and 2-point discrimination. Reflexes were normal and symmetrical. Muscle strength was normal without evidence of atrophy. His gait was tandem. He was diagnosed with lower extremity peripheral neuropathy. VA treatment records reflect that in July 2011 the Veteran reported diminished sensation in both feet. He denied pain or tingling. In April 2012 he reported bilateral foot pain for the prior couple of months, mostly on the sole of the foot, worse with ambulating, and worse on the right. His physician noted that examination was benign and his diabetes was very well controlled, so it was suspected that this may be a neuroma and not neuropathy. In an August 2012 VA medical opinion based on a review of the claims file, a VA examiner gave an opinion regarding the etiology of the Veteran’s neuropathy but did not discuss its severity. In his March 2013 notice of disagreement, the Veteran through his representative reported that his peripheral neuropathy is wholly sensory and worsening. He reported difficulty sitting because his legs go to sleep and difficulty walking due to pain. He stated that this makes it difficult for him to maintain a balanced schedule at work. He requested an evaluation of moderate, which he argued was more consisted with what he experienced as a result of pain and numbness in his lower extremities. The Veteran underwent another VA examination in March 2016. He reported intermittent sharp pain in both legs which occurs about every other month. He denied numbness and tingling in the lower extremities. The examiner noted severe bilateral intermittent pain attributable to peripheral neuropathy, but no paresthesias, dysesthesias, numbness, or constant pain. Muscle strength was full without atrophy. Reflexes and sensory examinations were normal. There were no trophic changes. Gait was normal. The examiner found no incomplete or complete paralysis in the nerves of the lower extremities and no other functional impairment. The Board finds that initial evaluations in excess of 10 percent are not warranted for the Veteran’s peripheral neuropathy of the lower extremities. Higher ratings are available for the equivalent of moderate incomplete paralysis, severe incomplete paralysis, or complete paralysis. The evidence weighs against such manifestations. Early in the appeal period, the Veteran reported decreased sensation to vibration in conjunction with flare-ups that occurred monthly. After 2012 there are no treatment records addressing the disability, and by his March 2016 VA examination the Veteran reported sharp pain that only occurs once per month. Indeed, the March 2016 VA examiner did not find even the equivalent of mild incomplete paralysis, a finding that is consistent with the lack of treatment records and the reports of pain that rarely occurs. For these reasons, the Board finds that initial evaluations in excess of 10 percent are not warranted for the Veteran’s peripheral neuropathy of the lower extremities. [SIGNATURE ON NEXT PAGE] JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Gallagher, Counsel