Citation Nr: 18160129 Decision Date: 12/21/18 Archive Date: 12/21/18 DOCKET NO. 16-40 951 DATE: December 21, 2018 ORDER Entitlement to a rating greater than 20 percent for Type-II diabetes mellitus with erectile dysfunction is denied. Entitlement to a 10 percent disability evaluation for hypertension is granted. Entitlement to a rating greater than 10 percent for peripheral neuropathy of the left lower extremity is denied. Entitlement to a rating greater than 10 percent for peripheral neuropathy of the right lower extremity is denied. Entitlement to a 70 percent disability evaluation for posttraumatic stress disorder (PTSD) for the rating period prior to December 15, 2017, is granted. Entitlement to a disability evaluation in excess of 70 percent for PTSD is denied. Entitlement to an effective date prior to April 7, 2007 for the grant of service connection for Type-II diabetes mellitus with erectile dysfunction is denied. Entitlement to an effective date prior to April 7, 2007 for the grant of service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to an effective date prior to April 7, 2007 for the grant of service connection for peripheral neuropathy of the right lower extremity is denied. Entitlement to an effective date prior to December 1, 2009 for the grant of service connection for Horner's Syndrome is denied. Entitlement to an effective date prior to December 1, 2009 for the grant of service connection for PTSD is denied. Entitlement to an effective date prior to September 6, 2007 for the grant of service connection for coronary artery disease, status-post angioplasty and aortocoronary bypass, is denied. REMANDED Entitlement to an increased disability evaluation for coronary artery disease, status-post angioplasty and aortocoronary bypass, rated as 10 percent disabling for the rating period prior to May 11, 2015, is remanded. Entitlement to an increased disability rating for coronary artery disease, status-post angioplasty and aortocoronary bypass, rated as 60 percent disabling for the rating period since May 11, 2015, is remanded. Entitlement to an increased disability evaluation for Horner’s Syndrome, currently rated as 10 percent disabling, is remanded. Entitlement to an increased disability evaluation for peripheral vascular disease of the left lower extremity, currently rated as 20 percent disabling, is remanded. Entitlement to an increased disability evaluation for peripheral vascular disease of the right lower extremity, currently rated as 20 percent disabling, is remanded. Entitlement to an effective date prior to June 22, 2017 for the grant of service connection for peripheral vascular disease of the left lower extremity is remanded. Entitlement to an effective date prior to June 22, 2017 for the grant of service connection for peripheral vascular disease of the right lower extremity is remanded. Entitlement to a total disability rating on the basis of individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran's diabetes mellitus with erectile dysfunction requires an oral hypoglycemic agent and restricted diet, but not regulation of activities. 2. The Veteran’s hypertension requires continuous medication. 3. Right lower extremity peripheral neuropathy is manifested by mild incomplete paralysis of the sciatic nerve. 4. Left lower extremity peripheral neuropathy is manifested by mild incomplete paralysis of the sciatic nerve. 5. For the entire rating period on appeal, the Veteran’s PTSD is productive of occupational and social impairment with difficulties in most areas, such as work, family relations, and mood, due to symptoms such as disturbance of mood and motivation, irritability, anxiety, sleep impairment, and depression; total occupational and social impairment was not shown. 6. The claim of entitlement to service connection for PTSD was granted following an application to reopen which was received by the RO on December 1, 2009. 7. The claim of entitlement to service connection for coronary artery disease, status-post angioplasty and aortocoronary bypass, was granted following a claim of entitlement to service connection which was received by the RO on September 6, 2007. At the time of the September 6, 2007 claim for service connection for coronary artery disease, status-post angioplasty and aortocoronary bypass, there was no prior claim for service connection of coronary artery disease, status-post angioplasty and aortocoronary bypass. 8. The claims of entitlement to service connection for diabetes mellitus with hypertension and erectile dysfunction and peripheral neuropathy of the right and left lower extremities were granted following claims of entitlement to service connection which were received by the RO on April 7, 2007. At the time of the April 7, 2007 claims for service connection for diabetes mellitus with hypertension and erectile dysfunction and peripheral neuropathy of the right and left lower extremities, there were no prior claims for service connection of diabetes mellitus with hypertension and erectile dysfunction and peripheral neuropathy of the right and left lower extremities. 9. The Veteran was granted service connection for Horner’s syndrome following a claim of entitlement to service connection which was received by the RO on December 1, 2009. At the time of the December 1, 2009 claim, there was no prior claim for service connection of Horner’s syndrome. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 20 percent for diabetes mellitus with erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.119, Diagnostic Code 7913 (2018). 2. The criteria for a separate 10 percent, but no higher, disability evaluation for hypertension have been met. 38 U.S.C. § 1155, 5103A, 5107(b); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7001 (2018). 3. The criteria for a disability evaluation in excess of 10 percent have not been met for right lower extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5103A, 5107(b); 38 C.F.R. §4.124a, Diagnostic Code 8520 (2018). 4. The criteria for a disability evaluation in excess of 10 percent have not been met for left lower extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5103A, 5107(b); 38 C.F.R. §4.124a, Diagnostic Code 8520 (2018). 5. The criteria for a disability rating of 70 percent, but no higher, for PTSD are met for the rating period prior to December 15, 2017. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.126, 4.130, Diagnostic Code 9411 (2018). 6. The criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.126, 4.130, Diagnostic Code 9411 (2018). 7. The criteria for entitlement to an effective date prior to December 1, 2009 for the grant of entitlement to service connection for PTSD have not been met. 8 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.114, 3.400 (2018). 8. The criteria for entitlement to an effective date prior to September 6, 2007 for the grant of service connection for coronary artery disease, status-post angioplasty and aortocoronary bypass, have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.114, 3.400 (2018). 9. The criteria for an effective date prior to April 7, 2007, for the grant of service connection of diabetes mellitus with hypertension and erectile dysfunction are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400 (2018). 10. The criteria for an effective date prior to April 7, 2007 for the grant of service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.114, 3.400 (2018). 11. The criteria for an effective date prior to April 7, 2007 for the grant of service connection for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3,114, 3.400 (2018). 12. The criteria for an effective date prior to December 1, 2009 for the grant of service connection of Horner’s syndrome have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from November 1966 to July 1973. These matters come before the Board of Veterans’ Appeals (Board) on appeal of September 2015, April 2016, and January 2018 rating decisions of the Regional Office (RO) of the Department of Veterans Affairs (VA) in Montgomery, Alabama. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The VCAA requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of the evidence that is necessary in substantiating their claims, and provide notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). In this case, the agency of original jurisdiction (AOJ) issued notice letters to the Veteran. The letters explained the evidence necessary to substantiate the Veteran’s application to reopen the previously denied claim of entitlement to service connection, as well as the evidence necessary to substantiate the claims of entitlement to service connection; the letters also explained the legal criteria for entitlement to such benefits. The claims for increased disability evaluations and earlier effective dates are downstream from the grant of service connection. The letters also informed him of his and VA’s respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA also has a duty to assist a veteran with the development of facts pertinent to the appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of “relevant” records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be “necessary” to decide the claim. 38 C.F.R. § 3.159(c)(4). The claims file contains the Veteran’s available service treatment records, reports of post-service treatment, and the Veteran’s own statements in support of his claims. The Veteran was afforded VA examinations responsive to the claims for the initial claims for service connection and the downstream claims for increased disability evaluations. The opinions were conducted by a medical professional, following thorough examination of the Veteran, solicitation of history, and review of the claims file. The examination reports contain all the findings needed to assess the Veteran’s service-connected disabilities on appeal, including history and clinical evaluation. See 38 C.F.R. § 3.327(a) (2018); Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007). The Board has reviewed the Veteran’s statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran’s claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met.   Increased Rating Disability Evaluation 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the service-connected disabilities on appeal have not materially changed and uniform evaluations are warranted for the rating period on appeal. 1. Entitlement to an increased disability evaluation for diabetes mellitus type II with erectile dysfunction, currently rated as 20 percent disabling The Veteran’s diabetes mellitus is rated as 20 percent disabling pursuant to 38 C.F.R. § 4.119, Diagnostic Code 7913. According to Diagnostic Code 7913, a 10 percent disability rating is assigned for diabetes mellitus manageable by restricted diet only. A 20 percent rating is warranted where the diabetes requires insulin and a restricted diet, or hypoglycemic agent and restricted diet. A 40 percent rating is warranted for diabetes requiring insulin, restricted diet, and regulation of activities. A 60 percent rating is warranted for diabetes requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted for diabetes requiring more than one daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated Within the criteria for a 100 percent rating, “regulation of activities” is defined as “avoidance of strenuous occupational and recreational activities.” This definition also applies to the “regulation of activities" criterion for a 40 percent rating under Diagnostic Code 7913. Camacho v. Nicholson, 21 Vet. App. 360, 363 (2007). Moreover, medical evidence is required to support this criterion for a 40 percent rating. Id. at 364. In addition, although VA regulations generally provide that symptoms need only more nearly approximate the criteria for a higher rating in order to warrant such a rating, see 38 C.F.R. §§ 4.7, 4.21, those regulations do not apply where, as here, the conjunction “and” is used and the criteria are successive, with the criteria for the lower ratings encompassed within those for higher ratings. Id. at 366; Tatum v. Shinseki, 23 Vet. App. 152, 155-56 (2009). In this case, the evidence reflects that the Veteran’s diabetes mellitus requires an oral hypoglycemic agent and a restricted diet. The dispositive question is therefore whether it also requires regulation of activities. The Board finds that it does not. At the most recent October 2017 VA examination, the VA examiner noted, after examining the Veteran and reviewing the claims file, that the Veteran's diabetes was treated by restricted diet and oral hypoglycemic agents. The examiner specifically noted that the Veteran’s diabetes mellitus did not require regulation of activities as part of medical management. Likewise, the Board observes that treatment records indicate that the Veteran’s diabetes mellitus is well controlled. As such, the Board finds that there is no medical evidence of “avoidance of strenuous occupational and recreational activities.” The Veteran did not indicate that any physician had told him to regulate his activities due to his diabetes. The Board acknowledges the Veteran's contentions that his diabetes has worsened since it was initially service connected and that he now must take an oral hypoglycemic agent whereas before he did not. However, the weight of the evidence is against a finding that the Veteran’s diabetes mellitus requires regulation of activities. As the higher ratings all require regulation of activities, the preponderance of the evidence is against a rating higher than 20 percent for the Veteran's diabetes mellitus. The benefit of the doubt doctrine is thus not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Entitlement to a separate disability evaluation for hypertension The Board finds that the Veteran is entitled to a separate, 10 percent disability evaluation for his hypertension pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7101. According to Diagnostic Code 7101, a 10 percent disability evaluation is warranted where diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or the individual has a history of diastolic pressure of 100 or more and requires continuous medication for control. See 38 C.F.R. § 4.104, Diagnostic Code 7101. For the next higher 20 percent disability evaluation, diastolic pressure must be predominantly 110 or more or systolic pressure must be 200 or more. A 40 percent disability evaluation requires diastolic pressure to be predominantly 120 or more, and a 60 percent disability evaluation requires diastolic blood pressure to be predominantly 130 or more. Id. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence demonstrates that a 10 percent disability evaluation, but no higher, is warranted for the Veteran’s hypertension. The Veteran's hypertension has required medication for control. However, there are no blood pressure readings demonstrating diastolic pressure predominantly 110 or more or systolic pressure of 200 or more. Therefore, the Veteran’s symptomatology most closely approximates the criteria for a separate, 10 percent disability evaluation. 3. Entitlement to an increased disability evaluation for peripheral neuropathy of the right and left lower extremities, each currently rated as 10 percent disabling The Veteran is currently assigned a 10 percent disability evaluation, per lower extremity, for right lower extremity peripheral neuropathy and a 10 percent disability evaluation for left lower extremity peripheral neuropathy pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under Diagnostic Code 8520, a 10 percent disability evaluation is warranted for mild incomplete paralysis of the sciatic nerve. A 20 percent evaluation is assigned for moderate incomplete paralysis and a 30 percent disability rating requires moderately severe incomplete paralysis. A 50 percent rating requires severe incomplete paralysis with marked muscular atrophy. An 80 percent disability rating requires complete paralysis; the foot dangles and drops, no active movement is possible of muscles below the knee, and flexion of the knee is weakened or lost. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at “Diseases of the Peripheral Nerves” in 38 C.F.R. § 4.124(a). After a review of all the evidence, the Board finds that the weight of the evidence demonstrates that the Veteran’s right and left lower extremity peripheral neuropathy is no more than mild. The evidence of record does not show that he experiences moderate incomplete paralysis of the right or left sciatic nerve. At the October 2017 VA examination, the VA examiner described the Veteran’s neurological manifestations as mild to moderate. To that extent, the Board points out that the Veteran had moderate paresthesias/dysthesias and numbness, without pain; the Veteran had decreased sensation of the upper anterior thigh and thigh/knee, foot and toes, and lower leg/ankle on the left only. Likewise, his reflexes were normal; muscle strength was full and there was no evidence of atrophy. Therefore, his symptomatology most closely approximates the criteria for the currently assigned 10 percent disability evaluation for mild incomplete paralysis of the sciatic nerve. In reaching this determination, the Board has considered the guidance provided by 38 C.F.R. §§ 4.120, 4.123, and 4.124. The Board finds that the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent, per lower extremity, for right and left lower extremity peripheral neuropathy for the entire appeal period, and the appeal for a rating in excess of 10 percent is denied. 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to an increased disability evaluation for posttraumatic stress disorder (PTSD), rated as 10 percent disabling prior to October 1, 2012, 30 percent disabling from October 1, 2012 to December 14, 2017, and 70 percent disabling from December 15, 2017 The Veteran’s PTSD is evaluated as 10 percent disabling for the initial rating period, prior to October 1, 2012, 30 percent disabling for the rating period from October 1, 2012 through December 14, 2017, and 70 percent disabling for the rating period since December 15, 2017 pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. A 10 percent disability evaluation is assigned under this code 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 disability rating is warranted where there is 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, chronic sleep impairment, and mild memory loss. See 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent disability rating requires 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-term 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; difficulty in establishing and maintaining effective work and social relationships. For the next higher 70 percent evaluation to be warranted, there must be occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood due to symptoms such as: suicidal ideation; obsessive 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 an inability to establish and maintain effective relationships. Id. A 100 percent rating is provided 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 minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. §§ 4.125-4.130. When determining the appropriate disability evaluation under the general rating formula, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact the veteran's occupational and social impairment. See Vazquez–Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed.Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list. Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be “due to” those symptoms, a veteran may only qualify for a given disability rating under the general rating formula by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 117–18. After a review of all the evidence, the Board finds that the Veteran’s service-connected PTSD more nearly approximates the criteria for a 70 percent disability evaluation for the entire rating period on appeal (since December 1, 2009). The Board finds that the Veteran’s psychiatric symptoms have been relatively consistent, and that the 70 percent evaluation takes into account the Veteran’s level of social and occupational impairment. Throughout the rating period on appeal, the Veteran’s PTSD has been characterized by occupational and social impairment with deficiencies in most areas, including work, thinking, and mood due to symptoms such as mild memory loss, depression, anxiety, irritability, and sleep impairment, as demonstrated by the findings at the October 2010 and December 2017 VA examinations, as well as his VA treatment records. The Veteran has complained of sleep impairment, hypervigilance, irritability, nightmares, intrusive thoughts, decreased interest, anxiety, and depression at his VA examinations and in seeking treatment at VA (see i.e., January 2012, October 2014, March 2015 VA treatment records). He also reported experiencing social isolation and impaired memory, as well as difficulty concentrating. A 70 percent disability evaluation accounts for the Veteran’s social and occupational impairment as caused by these symptoms. The evidence does not show that the Veteran experienced total occupational and social impairment due to his symptoms at any time during the rating period on appeal. Initially, the Board notes that he did not demonstrate manifestations such as grossly impaired thought processes, delusions and hallucinations, persistent danger of hurting himself or others, or intermittent inability to perform activities of daily living, as contemplated in the listed criteria for a 100 percent disability rating under Diagnostic Codes 9411-9433. In fact, the VA examination report and treatment records indicate that the Veteran is able to communicate effectively and that he is alert and oriented, with appropriate speech; he also had good hygiene and insight. While the Board recognizes the Veteran’s significant occupational and social impairment, it is not total. His symptoms do not equate in frequency, duration or severity with total occupational or social impairment. The December 2017 VA examiner noted that the Veteran does not lack social relationships; he was married for 31 years, has been in a long-term romantic relationship for 20 years since his divorce, and has good relationships with his children. For these reasons, the Board finds that the evidence supports a finding of a 70 percent evaluation, but no higher, for the entire rating period on appeal. 38 C.F.R. §§ 4.3, 4.7. Effective Date Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increased, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application therefor. 38 U.S.C. § 5110(a). The effective date of an award of disability compensation to a veteran is the day following the date of discharge or release if the application therefor is received within one year from such date of discharge or release. 38 U.S.C. § 5110(b)(1). The effective date for the receipt of new and material evidence other than service department records turns on whether the evidence was received within the appeal period or prior to the appellate decision being issued, if so, the effective date will be as though the former decision had not been rendered. If the new and material evidence is received after the final disallowance, the effective date will be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q). A claim is defined as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. §§ 3.1(p) (2018). The Board notes that, effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2). These amendments, however, are only applicable with respect to claims and appeals filed on or after March 24, 2015, and are not applicable in the present case, except for the claim of entitlement to an earlier effective date for the grant of service connection for tension headaches. Id. at 57,686. The Court has made it clear that the date of the filing of a claim is controlling in determinations as to effective dates. A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). In arguing for the assignment of earlier effective dates for the awards of service connection, the Veteran argues that his award of service connection should be retroactive; the Veteran did not specify a retroactive effective date to which he felt entitled, nor did he state his reasons for seeking an earlier effective date. 1. Entitlement to an effective date prior to April 7, 2007 for the grant of service connection for diabetes mellitus type II with hypertension and erectile dysfunction 2. Entitlement to an effective date prior to April 7, 2007 for service connection peripheral neuropathy of the left lower extremity 3. Entitlement to an effective date prior to April 7, 2007 for service connection peripheral neuropathy of the right lower extremity 4. Entitlement to an effective date prior to December 1, 2009 for service connection Horner's Syndrome 5. Entitlement to an effective date prior to September 6, 2007 for the grant of service connection for coronary artery disease, status-post angioplasty and aortocoronary bypass Here, the Veteran separated from service in 1973, but he did not file claims for service connection of diabetes mellitus, peripheral neuropathy of the right and left lower extremities, coronary artery disease, or Horner’s syndrome within one year of his separation from service in 1972; thus, an effective date of the date after separation from service is not warranted. 38 U.S.C. § 5110(b); 38 C.F.R. 3.400(b) (2018). Review of the record shows that the first claim demonstrating an intent to apply for benefits for diabetes mellitus and peripheral neuropathy of the right and left lower extremities was received on April 7, 2007; the first claim demonstrating an intent to apply for benefits for coronary artery disease was received on September 6, 2007, and the first claim demonstrating intent to apply for benefits for Horner’s syndrome was December 1, 2009. Thus, earlier effective dates based on prior, pending, unadjudicated claims are not warranted. Id. To the extent that the Veteran argues that he should be entitled to an earlier effective date based on the diagnosis of diabetes mellitus, peripheral neuropathy of the right and left lower extremities, coronary artery disease, or Horner’s syndrome, the Board points out that there is no provision in the law for awarding an earlier effective date based simply on the presence of the disability or treatment therefor. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (the mere presence of medical evidence of a condition does not establish an intent on the part of the veteran to seek service connection for the disability). See also 38 C.F.R. § 3.155(a) (requiring claimants to file formal application after informal claim is accepted and proper form is provided). Thus, his date of first treatment cannot serve as the date of claim in this case as there was no intent to file for benefits at that time. As noted, an effective date is assigned based on when entitlement arose or the date the claim was received, whichever is later. In this case, the Board acknowledges the Veteran’s post-service onset dates for his diabetes mellitus, peripheral neuropathy of the right and left lower extremities, coronary artery disease, and Horner’s syndrome. However, the date the Veteran’s claims for service connection for diabetes mellitus and peripheral neuropathy of the lower extremities were first received was April 7, 2007; and the Veteran’s claims for service connection of coronary artery disease and Horner’s syndrome were first received on September 6, 2007 and December 1, 2009, respectively. No prior claims are of record, thus, even if entitlement arose in service or prior to these dates, the date of receipt of the claims is the later of the dates, and is the proper effective date for the award of service connection for all of these disabilities. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (2018). Therefore, under the laws and regulations pertaining to effective dates, April 7, 2007 is the appropriate effective date for the grant of entitlement to service connection for diabetes mellitus and peripheral neuropathy of the right and left lower extremities, September 6, 2007 is the appropriate date for the grant of entitlement to service connection for coronary artery disease, and December 1, 2009 is the appropriate effective date for the grant of entitlement to service connection for Horner’s syndrome. 6. Entitlement to an effective date prior to December 1, 2009 for the grant of service connection for PTSD The record shows that the Veteran initially filed a claim of entitlement to service connection for cyclomatic character behavior disorder in August 1973. His claim was denied in an April 1974 rating decision. No evidence was submitted within one year of this denial and no appeal was taken from this denial. Thus, it became final. On December 1, 2009, VA received the Veteran’s application to reopen the claim of entitlement to service connection for cyclomatic character behavior disorder. The Veteran’s claim was recharacterized as an application to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The Veteran’s application to reopen was denied in November 2010, and the Veteran filed a notice of disagreement. In February 2015, the Board reopened the Veteran’s claim and granted service connection for PTSD. A September 2015 rating decision effectuated this decision, and assigned an effective date of December 1, 2009. Reviewing the evidence, the Board finds that the Veteran’s current claim is one to reopen and not a claim for direct service connection. His initial claim for compensation for an acquired psychiatric disorder was received in August 1973 and was finally denied in April 1974, thus, any subsequent claim would be an attempt to reopen this finally denied claim. As a result, the provisions of section 3.400(q) are applicable here and not those governing the assignment of an effective date for direct service connection claims. The Veteran’s August 1973 claim for benefits based on an acquired psychiatric disorder was finally adjudicated in an April 1974 rating decision. No relevant evidence or formal or informal claim relating to compensation for an acquired psychiatric disorder was received by VA prior to December 1, 2009. Accordingly, the April 1974 rating decision is a prior final disallowance, and the Board finds that December 1, 2009 represents the earliest possible date for the date a claim was received. Applying the regulations discussed above, the effective date for a grant of service connection following a final prior disallowance is the date of receipt of the application to reopen, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (2018). If entitlement arose prior to December 1, 2009, the date the application to reopen was received, then, December 1, 2009 is the later date and the appropriate effective date; if entitlement arose after December 1, 2009, then the Veteran is still not entitled to an effective date earlier than December 1, 2009, as the effective date should be the later of the date of receipt of claim or the date entitlement arose. As such, the AOJ assigned the earliest possible effective date for its grant of entitlement to service connection for PTSD. See Leonard v. Nicholson, 405 F.3d 1333 (Fed. Cir. 2005); Sears v. Principi, 349 F.3d 1326 (Fed. Cir. 2003). In conclusion, the Board finds that December 1, 2009 is the earliest possible date for which the Veteran is entitled to an award of service connection for PTSD. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (2018). REASONS FOR REMAND 1. Entitlement to an increased disability evaluation for coronary artery disease, status-post angioplasty and aortocoronary bypass, rated as 10 percent disabling for the rating period prior to May 11, 2015, is remanded. 2. Entitlement to an increased disability rating for coronary artery disease, status-post angioplasty and aortocoronary bypass, rated as 60 percent disabling for the rating period since May 11, 2015, is remanded. The Board observes that the Veteran submitted multiple Disability Benefit Questionnaires (DBQ) for in support of his claim for increased disability evaluations for his coronary artery disease, status-post angioplasty and aortocoronary bypass. The DBQs were completed by his private physician, W. K., M.D. The Veteran has also submitted private medical records from Dr. K. in support of his claim. In both instances, Dr. K. indicates that he does not treat the Veteran for his coronary artery disease, and that the Veteran receives treatment for his coronary artery disease from Dr. P., a private cardiologist. To this point, the Board observes that Dr. K indicated that the Veteran has undergone multiple EKG and ECG related to his coronary artery, but that he did not have copies of the results; of note, Dr. K referenced EKG and ECGs performed in March 2009, December 2013, and October 2014. Moreover, in completing a November 2014 coronary artery disease DBQ, Dr. K indicated that he could not complete the examination because he did not have the access to the relevant treatment records. Moreover, it is unclear from the record whether the Veteran also receives treatment for his coronary artery disease at a VA Medical Center. Because these private and VA treatment records could bear on the matter of his entitlement to increased disability ratings for his coronary artery disease, status-post angioplasty and aortocoronary bypass, efforts must be made to procure them. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). See also Bell v. Derwinski, 2 Vet. App. 611 (1992) (holding that VA is charged with constructive notice of medical evidence in its possession). 3. Entitlement to an increased disability evaluation for Horner's syndrome, currently rated as 10 percent disabling, is remanded. The Veteran asserts that his Horner’s syndrome symptomatology is more severe than presently evaluated. The Veteran has not been provided with an examination which considers the current severity of his condition. As such, the Board finds that the Veteran should be afforded a new VA examination in order to accurately evaluate the current severity of his service-connected Horner’s syndrome. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that the Veteran was entitled to a new examination after a two-year period between the last VA examination and the Veteran's contention that the pertinent disability had increased in severity). 4. Entitlement to an increased disability evaluation for peripheral vascular disease of the left lower extremity, currently rated as 20 percent disabling, is remanded. 5. Entitlement to an increased disability evaluation for peripheral vascular disease of the right lower extremity, currently rated as 20 percent disabling, is remanded. 6. Entitlement to an effective date prior to June 22, 2017 for the grant of service connection for peripheral vascular disease of the left lower extremity is remanded. 7. Entitlement to an effective date prior to June 22, 2017 for the grant of service connection for peripheral vascular disease of the right lower extremity is remanded. The RO, in a January 2018 rating decision, granted separate disability evaluations for the Veteran’s service-connected peripheral vascular disease, effective December 27, 2017. In February 2018, the Veteran submitted a VA Form 21-0958, Notice of Disagreement, indicating that he disagreed with the disability ratings assigned for his peripheral vascular disease of the right and left lower extremities, as well as the effective date for the grants of entitlement to service connection. Because the Veteran filed a notice of disagreement as to these issues, the Veteran was entitled to a statement of the case addressing the issues of entitlement to increased disability ratings for peripheral vascular disease of the right and left lower extremities as well as the issues of entitlement to earlier effective dates for the grants of service connection for peripheral vascular disease of the right and left lower extremities. When a claimant files a notice of disagreement to an issue, the Veteran is entitled to a statement of the case addressing the issue. When a claimant has filed a notice of disagreement and there is no statement of the case on file for that issue, the Board must remand, not refer, the issue to the RO for issuance of a statement of the case. Manlincon v. West, 12 Vet. App. 238 (1999). 8. Entitlement to TDIU The TDIU claim is part and parcel of an increased rating claim being referred to the RO, and vice versa. Rice v. Shinseki, 22 Vet. App. 447 (2009). Given that additional development is required as to the Veteran’s claims for increased disability ratings for his service-connected Horner’s syndrome and coronary artery disease, status-post angioplasty and aortocoronary bypass, the Board finds that a decision on the remaining issue of entitlement to TDIU must be deferred to allow the RO the opportunity to evaluate the Veteran’s service-connected disabilities on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc). The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his service-connected disabilities on appeal. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records, including records from his private cardiologist, Dr. P. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. After any additional records are associated with the claims file, the RO should schedule the Veteran for an appropriate VA examination to ascertain the current severity and manifestations of his service-connected Horner’s syndrome. The claims file should be made available to the examiner for review in connection with the examination. Any indication that the Veteran’s complaints or other symptomatology are not in accord with the objective findings on examination should be directly addressed and discussed in the examination report. The VA examiner should provide a complete rationale for any opinions provided. 3. The RO should issue a statement of the case regarding the issues of entitlement to increased disability ratings for peripheral vascular disease of the right and left lower extremities as well as the issues of entitlement to earlier effective dates for the grants of service connection for peripheral vascular disease of the right and left lower extremities. The Veteran and his representative should be advised that, for the Board to have jurisdiction of this matter, a timely substantive appeal must be filed. 4. After completing all indicated development, the RO should readjudicate the Veteran’s claims for increased disability ratings for service-connected coronary artery disease, status-post angioplasty and aortocoronary bypass, and Horner’s syndrome, as well as the claim of entitlement to TDIU. If any of the claims remain denied, the Veteran should be furnished with a supplemental statement of the case and afforded a reasonable opportunity for response. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel