Citation Nr: 18160880 Decision Date: 12/28/18 Archive Date: 12/27/18 DOCKET NO. 15-42 853 DATE: December 28, 2018 ORDER Entitlement to a 50 percent rating for headaches is granted. Entitlement to a rating in excess of 30 percent prior to March 15, 2016 for posttraumatic stress disorder (PTSD), and in excess of 50 percent thereafter, is denied. Entitlement to an effective date prior to January 22, 2015 for the grant of service connection for headaches is denied. Entitlement to an effective date prior to January 22, 2015 for the grant of service connection for a lumbosacral strain is denied. Entitlement to service connection for astigmatism is denied. REMANDED Entitlement to an initial compensable rating for pseudofolliculitis barbae (PFB) is remanded. Whether new and material evidence was received to reopen a claim of entitlement to service connection for a traumatic brain injury (TBI) is remanded. Entitlement to a rating in excess of 10 percent for lumbosacral strain claimed as a low back condition is remanded. Entitlement to a total disability rating based on individual unemployability is remanded. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, his service-connected headache disorder is manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 2. Prior to March 15, 2016 the Veteran’s PTSD symptoms were manifested by occupational and social impairment resulting a decrease in work efficiency and intermittent periods of an inability to perform occupational tasks. 3. After March 15, 2016 the Veteran’s PTSD symptoms were manifested by occupational and social impairment with symptoms resulting in reduced reliability and productivity. 4. The Veteran was service connected for his headaches effective January 22, 2015, the date of the claim. 5. The Veteran was service connected for his lumbosacral strain effective January 22, 2015, the date of the claim. 6. The Veteran does not have a current disability of the eye for VA purposes. CONCLUSIONS OF LAW 1. The criteria for a maximum rating of 50 percent, for headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.21, 4.124a, Diagnostic Codes 8100. 2. The criteria for a rating in excess of 30 percent prior to March 15, 2016 and in excess of 50 percent thereafter for PTSD have not been satisfied or more nearly approximated at any point during the pendency of this claim. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.130, Diagnostic Code 9411. 3. The criteria for the assignment of an earlier effective date than January 22, 2015, for headaches have not been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.155, 3.400. 4. The criteria for the assignment of an earlier effective date than January 22, 2015, for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.155, 3.400. 5. The criteria for service connection for astigmatism are not satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2006 to August 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from September 2012, November 2015, and July 2015 rating decisions of the Department of Veteran Affairs (VA) Regional Offices (RO) in San Diego, California and Newark, New Jersey. The RO in Philadelphia, Pennsylvania currently has jurisdiction over the case. Notably, the September 2012 rating decision granted service connection for adjustment disorder and assigned a 30 percent rating effective from August 20, 2012. A May 2018 rating decision recharacterized the disability as PTSD and increased the assigned rating to 50 percent from March 15, 2016. The Veteran’s representative then filed a notice of disagreement in response to the May 2018 rating decision contesting the effective date of the increase. However, the 30 percent rating effective prior to March 15, 2016 is already on appeal. Therefore, the issue of an “earlier effective date” for the 50 percent rating is moot because the Board is already adjudicating the issue of whether a rating of 50 percent or higher is warranted prior to March 15, 2016. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Increased Rating VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The schedule recognizes that disability from distinct injuries or diseases may overlap. See 38 C.F.R. § 4.14. However, the evaluation of the same disability or its manifestation under various diagnoses, which is known as pyramiding, is to be avoided. Id. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower ratings for segments of time during the period on appeal in accordance with such variations, if such is supported by the evidence of record. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); see also Fenderson v. West, 12 Vet. App. 119, 126 (1999) (holding that staged ratings may be warranted in initial rating cases). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim, or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2015). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to a 50 percent rating for headaches The Veteran’s headaches have been assigned a noncompensable rating, under Diagnostic Code (DC) 8100, which pertains to migraines. See 38 C.F.R. § 4.124a. Under DC 8100, a 10 percent rating is assigned for characteristic prostrating attacks averaging one in 2 months over the last several months; a 30 percent evaluation is assigned for characteristic prostrating attacks occurring on an average once a month over the last several months; and the maximum 50 percent rating is assigned for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a. The regulation does not define “economic inadaptability.” The U.S. Court of Appeals for Veterans Claims (Court) has held that under DC 8100, a headache disorder need only be “capable of producing” economic inadaptability, and that this standard is different from the “unemployability” standard applicable in the context of determining entitlement to a total disability rating based on individual unemployability (TDIU). Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004); see 38 C.F.R. §§ 3.340, 4.16 (setting forth the requirements for establishing entitlement to TDIU). The term “prostrating” under DC 8100 is also not defined. In its Adjudication Procedures Manual, the Veterans Benefits Administration (VBA) defines “prostrating” for purposes of applying DC 8100 as “causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.” VBA Manual M21-1, III.iv.4.G.7.b. “Completely prostrating” is defined as “extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.” Id. The Court has similarly noted in a non-precedential memorandum decision, in reference to DC 8100, that the term “prostration” has been defined by Dorland’s Medical Dictionary as “extreme exhaustion or powerlessness.” Felder v. McDonald, 2016 WL 1295022 (April 1, 2016). While these definitions are not binding on the Board, they offer persuasive guidance, and the Board is not aware of any alternative definition or interpretation of this term as used in DC 8100. Finally, the Court has indicated that the Board must consider the provisions of 38 C.F.R. § 4.21 in applying DC 8100, which states that “it is not expected... that all cases will show all the findings specified” in the rating criteria, but that “findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function... will be expected in all instances.” Pierce, 18 Vet. App. at 447. In evaluating the medical evidence of record, the Board finds that, the symptoms associated with the Veteran’s headache disorder are more closely approximated by the criteria for a 50 percent rating under DC 8100, for the entire period on appeal. This is the highest schedular rating available under this diagnostic code. See 38 C.F.R. § 4.124(a). The Board notes that most of the Veteran’s symptoms associated with his headache disability are subjective; however, the Veteran is competent to state that he has had severe headaches that cause him frequent incapacitation and affected his job performance and attendance. Headaches are a type of disorder that can be easily identified by a lay person who is experiencing this symptomatology. See Jandreau, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Moreover, there is no reason to doubt his credibility when he indicates the severity of the headaches he is experiencing. The Veteran was provided a VA C&P Examination in October 2015. The examiner found the Veteran to have headaches that last less than a day and occur 2-3 times a week. The headaches occur of both sides of his head and the pain is constant. The headaches are accompanied by nausea, photophobia, and phonophobia. The examiner also found that the attacks were not prostrating The Veteran submitted a private examination conducted by Dr. Skaggs in November 2016. See November 2016 Headaches DBQ. The doctor found the Veteran to have prostrating headaches occurring more than 20 times a month and lasting between 7-36 hours at a time. The headaches are accompanied by nausea, photophobia, phonophobia, vertigo, and changes in vision. The Veteran was reported to wear shaded glasses to reduce light exposure due to his photosensitivity and needed to lie in a quiet dark room at least 7 times a month. The doctor also submitted a residual functional capacity assessment. The report focuses on the impact of the Veteran’s headaches on his functioning. Dr. Skaggs concluded that the Veteran was unable to sustain work in any employment base due to his migraines. The doctor opined that the Veteran has experienced migraines of the present severity since leaving service. See November 2016 DBQ Headaches. The Veteran’s VA treatment records also show that the Veteran suffers approximately 20 headaches a month lasting at least 7 hours. See December 2012 Neurology Consultation Note; December 2014 Neurology Attending; December 2014 Neurology Consult. The headache usually occurred behind the forehead behind the eyes and build during the day. See July 2015 Polytrauma Note; October 2015 Physical Therapy Note. The Veteran takes both prescription and over the counter medications for his headaches in addition to lying down in a dark quite room. See July 2015 Polytrauma Note; July 2015 Neurology Consultation. While the Board recognizes the negative evidence in the way of the October 2015 VA examination, it notes that the examiner did not consider the duration in terms of hours with which the Veteran’s headaches lasts. In addition, the examiner did not note the remedies the Veteran uses to treat his headaches. Accordingly, affording the Veteran the benefit of the doubt, the evidence of record suggests that his headaches have been very frequent, completely prostrating, prolonged, and productive of severe economic inadaptability. Therefore, a 50 percent rating is warranted. This is the maximum rating available under DC 8100. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). 2. Entitlement to a rating in excess of 30 percent prior to March 15, 2016 and in excess of 50 percent thereafter for PTSD previously rated as an adjustment disorder 3. Entitlement to an effective date prior to March 15, 2016, for the award of a 50 percent schedular rating for the service connected PTSD previously rated as an adjustment disorder For the reasons that follow, the Board concludes that 30 percent disabling prior to March 15, 2016 and 50 percent thereafter is warranted for the Veteran’s PTSD. The Veteran’s service-connected PTSD is currently evaluated as 30 percent disabling prior to March 15, 2016 and 50 percent thereafter, under 38 C.F.R. § 4.130, Diagnostic Code 9411, according to VA’s General Rating Formula for Mental Disorders. See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1. Under the General Rating Formula, as pertinent to the present appeal, 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). 38 C.F.R. § 4.130. A 50 percent rating is warranted where the disorder is manifested by 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 and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent rating requires occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, 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 as 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. Id. The maximum 100 percent rating requires 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 minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. The symptoms associated with each evaluation under the General Rating Formula do not constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Thus, the evidence considered in determining the appropriate evaluation of a psychiatric disorder is not restricted to the symptoms set forth in the General Rating Formula. See id. Rather, VA must consider all symptoms of a claimant’s condition that affect his or her occupational and social impairment. Id. The Federal Circuit recently clarified that the General Rating Formula for Mental Disorders requires not only (1) sufficient symptoms of the kind listed in the percentage requirements, or others of similar severity, frequency or duration; but also (2) that those symptoms cause the level of occupational and social impairment specified in the regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). If the evidence demonstrates that the claimant’s psychiatric disorder produces symptoms and resulting occupational and social impairment equivalent to that set forth in the criteria for a given rating in the General Rating Formula, then the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. In this regard, the Board must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (noting that the “frequency, severity, and duration” of a veteran’s symptoms “play an important role” in determining the disability level). While VA considers the level of social impairment, it shall not assign an evaluation based solely on social impairment. Id. Evaluating all the evidence of record, the Board finds that the frequency, severity, and duration of the Veteran’s reported PTSD symptomatology more closely approximates the criteria for a 30 percent rating prior to March 15, 2016 and 50 percent thereafter. In this regard, the evidence reflects that the Veteran’s PTSD is productive of occupational and social impairment with no more than reduced reliability and productivity. See 38 C.F.R. § 4.130, DC 9411. Prior to March 15, 2016, the Veteran’s psychiatric examination reports indicate anxiety; depression; chronic insomnia; isolating behaviors; flashbacks, hypervigilance, and mild symptoms which decrease occupational and social functioning. See, e.g., August 2012 VA C&P Examination Report (noting depression, anxiety, and chronic sleep impairment); April 2014 Primary Care Outpatient Note (reflecting depression, anxiety, insomnia, nightmares); June 2014 Mental Health Evaluation Note (noting nightmares, depression, anxiety); June 2014 Mental Health Note (reflecting good long-term memory, no hallucination, goal oriented thought process); May 2015 Behavioral Health Note (reflecting nightmares, flashbacks, avoidance of crowds, intrusive thoughts). After March 15, 2016, the Veteran the Veteran’s reports indicates anxiety, depression, suspiciousness, mild memory loss, impaired impulse control, panic attacks, chronic sleep impairment, and occupational and social impairment with decreased work efficiency. See March 2016 VA C&P Examination Report (noting depressed mood, anxiety, suspiciousness, panic attack, chronic sleep impairment, mild memory loss, difficulty in establishing relationships, impaired impulse control); March 2017 Mental Health Note (noting sleep trouble, nightmares, hyper-startle, hypervigilance, paranoia, irritability); April 2018 Mental Health Outpatient Note (noting Veteran has trouble sleeping, difficulty focusing, flashbacks, low motivation, nightmares, irritability, avoidance of crowds) The Board notes that the Veteran underwent an evaluation with a private medical examiner, Dr. Wilson, in November 2016. Dr. Wilson found the Veteran to suffer from daily panic attacks, chronic sleep impairment, nightmares, obsessional rituals, unprovoked irritability, mild memory loss, neglect of personal hygiene, passive suicidal thoughts, persistent delusions, and audio hallucinations. See November 2016 Mental Review; November 2016 Mental DBQ. The doctor also found the Veteran to suffer from flattened affect, impaired judgment, impaired abstract thinking, and intermittent inability to perform activities of daily living. Id. The doctor reflected that the Veteran’s mental health symptoms caused occupational and social impairment with deficiencies in most areas and prevented him from gaining and maintaining substantial employment. Throughout the appellate period the Veteran has had two children with whom he has maintained contact with. See March 2015 VA C&P Examination Report. One of the children is from his previous marriage while the other is from his girlfriend. See generally, August 2012 VA C&P Examination Report. The Veteran describes his relationship with his ex-wife as good and his relationship with his girlfriend as rocky. See August 2012 VA C&P Examination Report (noting the Veteran intends to marry his girlfriend); June 2014 Mental Health Evaluation Note (reflecting the Veteran has a good relationship with his ex-wife); March 2017 Mental Health Outpatient Note (reflecting he broke up with his girlfriend 8 months ago); April 2018 Mental Health Outpatient Note (reflecting the Veteran had an improving relationship with his girlfriend). Upon review of the record, the Veteran’s VA and private treatment records reflect essentially consistent symptoms associated with his PTSD including depression, anxiety, irritability/anger, problems with concentration, nightmares, intrusive thoughts, sleep disturbance, panic attacks, and impaired memory. Other symptoms/findings noted primarily in the private treatment records include suicidal ideation, audio hallucinations, delusions, and a flattened affect. As per Dr. Wilson’s opinions concerning the Veteran’s social and occupational impairment, the Board has considered the Veteran’s records reflecting suicidal ideation, hallucinations, and an inability to manage appropriate hygiene. This November 2016 opinion is bookended by various medical treatment records which found the Veteran to deny these same symptoms. See June 2014 Mental Health Evaluation Note (reflecting the Veteran denies audio/visual hallucinations and denies passive suicidal ideation thoughts); May 2015 Behavioral Health Note (reflecting the Veteran denied suicidal ideation and hallucinations); April 2018 Mental Health Outpatient Note (reflecting no suicidal ideation, homicidal ideation, or audio/visual hallucinations). While the Veteran’s medical treatment records note an instance where the Veteran contemplated jumping from a window, it also noted that the Veteran contracts for safety. See March 2017 Mental Health Outpatient Note. Further, the Veteran was continuously found to be well groomed, with good insight and judgment. See May 2015 Behavioral Health Note (reflecting the Veteran is well groomed and casually dressed with normal speech and linear thought process); March 2016 VA C&P Examination Report (reflecting the Veteran was casually dressed with proper hygiene and appeared his stated age); March 2017 Mental Health Outpatient Note (reflecting the Veteran is well groomed, casually dressed and cooperative with linear, goal oriented thoughts); March 2018 Social Work Note (noting the Veteran leased a new apartment and is well groomed with normal thought processes). As such, the Board finds the opinion of Dr. Wilson to hold low probative value. In their entirety, the Board finds that the Veteran’s symptoms are similar in severity, frequency and duration to those warranting a 30 percent disability rating until March 15, 2016 and 50 percent thereafter. As set forth above, prior to March 2016 the Veteran’s symptoms were manifested by depressed mood, anxiety, suspiciousness, panic attacks weekly or less often, mild memory loss, and chronic sleep impairment. After March 2016 the Veteran’s symptoms were manifested by the addition of impaired impulse control. Upon review of Dr. Wilson’s records, the Veteran’s suicidal ideation, audio and visual hallucinations, and lack of adequate hygiene could only be described as occasional in occurrence. There is no evidence the Veteran’s symptoms of improper hygiene or hallucinations are persistent. Thus, the symptoms are all contemplated by and consistent with the currently assigned disability ratings. Accordingly, although there have been fluctuations in severity of the Veteran’s PTSD over the course of the appeal, the preponderance of the evidence shows that it has not met or more nearly approximated the criteria for a rating in excess of 30 percent prior to March 15, 2016 or in excess of 50 percent thereafter. See 38 C.F.R. § 4.130, DC 9411. Consequently, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Effective Dates 4. Entitlement to an earlier effective date prior to January 22, 2015 for the grant of service connection for headaches 5. Entitlement to an earlier effective date prior to January 22, 2015 for the grant of service connection for a lumbosacral strain Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an evaluation and an award of compensation based on a reopened claim is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2). 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, it is the date of receipt of claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. With respect to the date of claim, a specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under VA law. 38 U.S.C. §§ 501, 5101; 38 C.F.R. § 3.151. The Veteran contends that he is entitled to the earlier effective date than January 22, 2015 for his service connected headaches and lumbosacral strain. See January 2016 Notice of Disagreement. The Veteran initially filed a claim for his headaches and lumbosacral strain in May 2013. See May 2013 Veteran Correspondence. The Veteran was denied service connection in a December 2013 rating decision and notified in a letter dated December 20, 2013. See December 2013 Rating Decision; December 2013 Notification Letter. The Veteran did not appeal this decision so it is considered final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. The Veteran filed to reopen the claims for entitlement to service connection for headaches and lumbosacral strain on January 22, 2015. See January 2015 Veteran’s Application for Compensation or Pension. A review of the record does not show any correspondence received after the prior final rating decision and prior to January 22, 2015 that could reasonably be construed as a claim for service connection for headaches or a low back disability. In a November 2015 rating decision, the Veteran was granted a non-compensable rating for his headache and a 10 percent rating for his lumbosacral strain. See November 2015 Rating Decision. The rating decision noted the effective date for these disabilities was January 22, 2015, the date the claim to reopen entitlement to service connection was received. Id. Based on the evidence of record, the Board finds that the Veteran is not entitled to an earlier effective date for his headaches and lumbosacral strain. The RO granted the Veteran service connection for his headaches and lumbosacral strain effective on the date the claim to reopen was received as per VA regulations. 38 C.F.R. § 3.400(q)(2). There is no theory of entitlement that would allow the Veteran to obtain an effective date earlier than the date the claim was received. Accordingly, as a matter of law, an earlier effective date for service connection for headaches and lumbosacral strain earlier than January 22, 2015 cannot be established. Brannon v. West, 12 Vet. App. 33, 34-5 (1998). Because the outcome of this issue is determined by the application of law to facts that are not in dispute, the benefit-of-the-doubt rule does not apply. See Sabonis v. West, 6 Vet. App. 426, 430 (1994); see also 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection 6. Entitlement to service connection for astigmatism is denied. Service connection will generally be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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). To establish service connection, the evidence must show (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link or nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 252 (1999). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The evidence does not show that the Veteran has a current disability of either eye for VA purposes. The Veteran’s entrance examination does not reference any disabilities of the eye. During service the Veteran was diagnosed with refractive errors of hypermetropia and astigmatism. See April 2009 STR Record. He was given glasses to treat his condition. Id. There is no documentation of any trauma to the eye. Id. Astigmatism is a refractive error of the eyes. Congenital or developmental defects, including refractive errors of the eyes, are not “diseases or injuries” for disability compensation purposes under VA law. See 38 C.F.R. §§ 3.303(c), 4.9; Palczewski v. Nicholson, 21 Vet. App. 174, 179 (2007). Accordingly, astigmatism does not qualify as a disease or injury for VA disability compensation purposes. Thus, because the Veteran’s astigmatism does not constitute a current disability, service connection may not be established. See Holton, 557 F.3d at 1366; Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997). As this claim must be denied as a matter of law, the benefit-of-the-doubt rule does not apply. See Sabonis v. West, 6 Vet. App. 426, 430 (1994).   REASONS FOR REMAND 7. Whether new and material evidence was received to reopen a claim of entitlement to service connection for a traumatic brain injury (TBI) is remanded. There appear to be outstanding VA treatment reports. In his medical treatment records, the Veteran mentioned losing consciousness during a bar fight in 2011. See Polytrauma Initial Evaluation. The Veteran noted that he was treated at Gerald Champion Hospital and had MRIs taken. Id. On remand, efforts should be undertaken to obtain these records. Moreover, because the claim is being remanded, any recent VA treatment records should be obtained. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(2). 8. Entitlement to an initial compensable rating for pseudofolliculitis barbae The Veteran’s service connected PFB is currently in receipt of an initial noncompensable (0 percent) rating under DC 7899-7828, which represents an unlisted disability of the skin evaluated as analogous to acne. See 38 C.F.R. §§ 4.118, DC 7806. See also 38 C.F.R. § 4.27 (providing that unlisted disabilities will be rated by analogy under a diagnostic code built up using the first 2 digits from that part of the Rating Schedule most closely identifying the body part or system affected and by using “99” for the last 2 digits, with an additional diagnostic code used to identify the basis for the evaluation assigned following a hyphen). DC 7828 provides for a noncompensable rating for superficial acne of any extent; a 10 percent rating for deep acne affecting less than 40 percent of the face and neck or deep acne other than on the face or neck; and a 30 percent rating for deep acne affecting more than 40 percent of the face or neck. The Veteran was afforded a VA examination in August 2012 and March 2015. While both examiners noted that the Veteran has a current diagnosis of pseudofolliculitis barbae, neither examiner reported the percentage of the Veteran’s exposed skin that is affected by the disorder. Without this information, the Board does not have sufficient information for which to decide the Veteran’s claim. Accordingly, the claim is remanded for a new VA examination. 9. Entitlement to a rating in excess of 10 percent for lumbosacral strain claimed as a low back condition is remanded. The U.S. Court of Appeals for Veterans Claims (Court) issued a precedential decision holding that for VA examinations to be adequate for rating musculoskeletal disabilities, they must record range of motion testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of motion of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016) (citing 38 C.F.R. § 4.59). Furthermore, if the examiner is unable to conduct the required testing, or concludes that the required testing is not necessary, he or she must clearly explain why that that is so. Id. at 170. The Veteran last underwent a VA examination in October 2015. At that time, range of motion the testing was done for the Veteran’s service-connected lumbosacral strain. However, the report does not specify the type of testing on which these results were based (i.e. active or passive, weight-bearing or nonweight bearing). Further, while the examiner reported that there was no evidence of pain with weight bearing, there is no record as to the results of these tests. Recent case law provides that an adequate VA examination of the joints should contain such inquires. Correia, Vet. App. at 169-70. As this is a determination that requires medical judgment, the Board may not make its own independent finding on this issue. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Thus, on remand, the AOJ should provide the Veteran an adequate VA examination. 10. Entitlement to a total disability rating based on individual unemployability is remanded. The Board notes that the Veteran’s claim for a TDIU is inextricably intertwined with the grant of an increased rating for his pseudofolliculitis barbae and lumbosacral strain. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). As such, consideration of the claim for TDIU must be deferred pending the resolution of the increased rating claims for pseudofolliculitis barbae and a lumbosacral strain. The matters are REMANDED for the following action: 1. Obtain the Veteran’s service personnel records. 2. Request from the Veteran a three-month period and a location regarding his exposure to any IED or mortar attacks. 3. Following completion of directive #2, request any outstanding inpatient clinical records from the base hospital pertaining to the Veteran’s period of bed rest after his IED exposure. See July 2015 Polytrauma Initial Evaluation Note (reflecting the Veteran treatment at a hospital after his IED exposure and was given a day or two of rest). 4. Request the Veteran’s treatment records and accompanying MRI reports regarding head injuries the Veteran sustained at Gerald Champion Hospital. 5. After the above is completed, schedule the Veteran for an appropriate VA examination to determine the current nature and etiology of his TBI disorder. The claims file should be made available to and reviewed by the examiner. All appropriate tests and studies should be performed and all clinical findings should be reported in detail. The examiner should provide an opinion as to the following: (a) Determine whether the Veteran suffered a traumatic brain injury. (b) Determine whether it is at least as likely as not that (50% or greater probability) the Veteran has any current residuals caused by an in-service head injury. In so doing, the examiner should also determine whether any of these symptoms are attributable to the Veteran’s service-connected PTSD, as opposed to a TBI. In making their determination, the examiner should note and consider: • The Veteran’s denial of any head injury. See January 2010 Post Deployment Assessment. • The Veteran’s statement that he hit his head on the sidewalk and loss consciousness and had a concussion after a fight in April 2012. See April 2013 Polytrauma Note. • Veteran noted he hit his head in 2008 and lost consciousness for a second, had a fight in New Mexico where he lost consciousness, and was attacked in November 2014 and hit his head on the ground. See December 2012 Neurology Consult. • The Veteran stated he suffered a concussion from an IED blast while on patrol in Iraq and hit his head on the side of a car. The Veteran notes losing consciousness a second time in a fight in 2011. See May 2015 Intake Evaluation The examiner should provide a comprehensive report including a complete rationale for all opinions and conclusions reached. 6. Schedule the Veteran for a VA examination to determine the nature and severity of his service connected pseudofolliculitis barbae. The examiner must review the claims file and should note that review in the report. All tests and studies deemed necessary by the examiner must be performed. If possible, the examiner should use the appropriate DBQ form. The examiner must provide specific findings as to the percentage of the entire body affected and the percentage of the exposed areas of the body affected by pseudofolliculitis barbae. The examiner should also assess the level of functional impairment associated with pseudofolliculitis barbae. 7. Schedule the Veteran for an appropriate VA examination to assist in determining the nature and current level of severity of his service-connected lumbosacral strain. The Veteran’s claims file, including a copy of this REMAND, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The examination should include any necessary diagnostic testing or evaluation, i.e. X-rays, etc. All pertinent symptomatology should be reported in detail. The examiner should test the range of motion using a goniometer in active motion, passive motion, weight-bearing, and non-weight bearing, for the hips and knees. See Correia v. McDonald, 28 Vet. App. 158 (2016). If the examiner is unable to conduct one or more of the above tests or finds that it is unnecessary, the examiner must provide an explanation. In any event, the type of test performed (i.e. active or passive, weightbearing or non-weight bearing), must be specified. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and any additional relevant evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. To the extent possible, the examiner must express any functional loss in terms of additional degrees of limited motion. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). The examiner must provide a comprehensive report including complete rationales for all opinions. The examiner should also assess the level of functional impairment associated with lumbosacral strain. Shamil Patel Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel