Citation Nr: 18115680 Decision Date: 07/03/18 Archive Date: 07/02/18 DOCKET NO. 12-26 945 DATE: July 3, 2018 ORDER Service connection for a respiratory disorder, characterized as residuals of pneumonia, to include chronic obstructive pulmonary disease (COPD), is denied. Service connection for hepatitis C is denied. Service connection for dental disability, claimed as dental injury due to a personal assault in service, is denied. Entitlement to an effective date earlier than February 9, 2011, for the grant of service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s current respiratory disability did not have its onset in service and is not etiologically related to service, including the in-service diagnosis of pneumonia. 2. The Veteran’s currently diagnosed hepatitis C is not related to his military service. 3. The Veteran is not shown to have a current dental disability due to loss of substance of body of maxilla or mandible from trauma or disease such as osteomyelitis. 4. The Veteran filed a formal claim of entitlement to service connection for PTSD on February 9, 2011. 4. In a March 2016 rating decision, the Veteran was granted service connection for PTSD, effective February 9, 2011, the date of the formal claim; there is no prior, unadjudicated claim, formal or informal, for psychiatric disability. 5. The Veteran’s sole service-connected disability, PTSD, does not render him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for service connection for a respiratory disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.301, 3.303 (2017). 3. The criteria for service connection for a dental disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 4.150 (2017). 4. The criteria for an effective date earlier than February 9, 2011, for the award of service connection for PTSD, have not been met. 38 U.S.C. §§ 5110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.155, 3.400 (2017). 5. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.19 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for 23 days from July 19, 1972, to August 11, 1972. This matter is before the Board of Veterans’ Appeals (Board) on appeal of the May 2012, March 2016, and November 2016 rating decisions. Historically, in a May 1975 rating decision, the Veteran was denied service connection for a respiratory disability and nervous condition. The Veteran did not file a timely appeal and the decision became final. The Veteran filed a claim in January 2011 for entitlement to service connection for hepatitis C and a respiratory condition, and shortly thereafter, filed a supplemental claim in February 2011 for service connection for depression/PTSD. In the May 2012 rating decision, the Veteran was denied service connection for PTSD, hepatitis C, and a respiratory disability. The Veteran filed a notice of disagreement and perfected his appeal in August 2012. Subsequently, in August 2015, the Board found there was new and material evidence, reopened the service connection claims for a respiratory disability and PTSD, and remanded the claims, along with the service connection claim for hepatitis C, for further development. Thereafter, the Veteran was granted service connection for PTSD in a March 2016 rating decision, with an initial 70 percent disability rating, effective February 9, 2011. The Veteran filed a notice of disagreement for an earlier effective date for the award of service connection for PTSD and perfected an appeal. In April 2016, the Veteran filed an Application for Increased Compensation Based on Unemployability, and in July 2016, the Veteran filed a supplemental claim for entitlement to service connection for a dental condition as residual of an in-service personal assault. In the November 2016 rating decision, the RO denied service connection for a dental disability and a TDIU. The Veteran filed a notice of disagreement, and perfected an appeal. The Board observes the claims of entitlement to an earlier effective date for the award of service connection for PTSD, service connection for a dental disability, and a TDIU were under a separate appeal stream, have been certified to the Board, and have now been merged with the instant appeal. The Board notes further that the attorney’s FOIA request was honored by the Board on March 29, 2018; at that time, the Board sent a copy of a CD with the Veteran’s records on it. Thereafter, an April 3, 2018 letter authored by the Veteran’s attorney asked for a copy of the records; however, it appears that this second request for records crossed in the mail with the CD that had already been sent. The Board finds that the FOIA request has been fully satisfied and there were no new records added to the file from March 29, 2018 to the April 3, 2018 request. The Veteran’s attorney, in June 2018 correspondence, requested a statement of the case in response to a notice of disagreement with the March 2016 rating decision. The Board notes that the RO awarded service connection for PTSD in the March 2016 rating decision and assigned a 70 percent rating. See also March 31, 2016 SOC. Thereafter, the RO issued a supplemental statement of the case in September 2016, which adjudicated the issue of entitlement to an earlier effective date for the award of service connection for PTSD; the SSOC was a part of the record when the Veteran’s complete file was sent to the attorney on CD in March 2018. The Veteran’s June 2018 records request is therefore moot. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also 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). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Alternatively, service connection may be granted on a presumptive basis for certain chronic diseases as outlined in 38 C.F.R. § 3.309 (a) if the Veteran served at least 90 days or more in service and if the chronic diseases are shown to be manifest to a degree of 10 percent or more within one year following the Veteran’s separation from active military service. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309. See also, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, as noted, the Veteran only served 23 days in service. Furthermore, the Veteran’s COPD, hepatitis C, and dental disability are not listed as chronic diseases, and as such Walker is not applicable here. The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give a Veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107 (b)). 1. Service connection for a respiratory disorder, characterized as residuals of pneumonia, to include COPD, is denied. The Veteran seeks service connection for a respiratory disability which he contends is a result of residuals of pneumonia that occurred while he was in service. Initially, the Veteran is currently diagnosed with COPD, as evidenced by an April 2011 VA examination. Service treatment records (STRs) dated August 1972 indicate the Veteran was admitted to the Air Force base hospital for possible pneumonia. Upon examination, the examiner noted diffused rhonchi with some rales in the Veteran’s left lower lobe posteriorly and in the right anterior lung field near the sternum. Chest x-ray findings were asymptomatic. The Veteran was discharged, but later returned to the hospital after complaints of a fever. The examiner found no significant change in the Veteran’s clinical picture, and repeat chest x-rays showed no change in the left pleural effusion, which was minimal. However, a repeat cold agglutin test was completed, and the Veteran was diagnosed with pneumonia, left lower lobe with pleural effusion, with a probable cause due to a mycoplasmal organism, and was started on Tetracycline for treatment. The July 1972 Report of Examination revealed a normal clinical evaluation of the respiratory system with no respiratory diagnoses. The Veteran was afforded a VA examination in April 2011 and reported that he had a history of respiratory and breathing problems since service. He stated that he had been healthy before service, but that 23 days after enlistment, he found himself “quarantined in the infections disease part of the hospital.” His current symptoms were coughing, congestion, spitting up, feeling tingly, being lightheaded, and having sleep problems. The examiner noted the Veteran had a positive history for asthma and bronchiectasis. X-rays showed emphysematous hyperaeration. After pulmonary function testing (PFT), the Veteran was diagnosed with COPD. In an April 2012 VA addendum medical opinion, the examiner opined that the Veteran’s COPD was less likely as not incurred in or caused by an in-service injury, event, or illness. The examiner after reviewing the record and examining the Veteran indicated that there was no credible medical evidence to support that pneumonia caused COPD. In a January 2018 treatment note, the Veteran was diagnosed with a mild asthma flare. In a January 2018 emergency department note, the Veteran complained of cough with green/gray sputum. The Veteran was diagnosed with acute bronchitis. Based on the review of the evidence of record, the Board finds service connection is not warranted for a respiratory disorder. Although there is evidence of a current disability and an in-service diagnosis of pneumonia, the weight of the competent evidence demonstrates that the Veteran’s currently diagnosed COPD is not related to service, including the in-service diagnosis of pneumonia. In making this determination, the Board finds the April 2011 VA examination and April 2012 addendum highly probative. The VA examiner reviewed the Veteran’s medical records, demonstrated an accurate knowledge of the Veteran’s medical history, and provided an adequate opinion and rationale. Moreover, there is no contrary competent medical opinion of record. The Board further finds that the Veteran’s diagnosed bronchitis and asthma is inclusive of his COPD diagnosis. Notably, COPD is defined as “any disorder characterized by persistent or recurring obstruction of bronchial air flow, such as chronic bronchitis, asthma, or pulmonary emphysema.” DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 530 (32nd ed. 2012). The Board has considered the Veteran’s statements and his sincere belief that his current COPD is related to his in-service pneumonia. The Veteran, as a layperson, is competent to attest to what he observes or senses, such coughing and congestion ever since service. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he is not competent to diagnose a respiratory disability or medically relate it to service, as he is not shown to possess the training and expertise to make these determinations. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Board finds that the Veteran’s lay statements as to etiology are inconsistent with, and outweighed by, the competent medical evidence of record. Based on the foregoing, service connection for a respiratory disorder, to include COPD, is not warranted in this case. The preponderance of the evidence indicates that the Veteran’s respiratory disorder is not etiologically related to the pneumonia noted in service, and it is not shown to otherwise be related to service. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran’s claim for service connection for a respiratory disability, that doctrine is not applicable in the instant appeal. See 38 U.S.C § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Therefore, the Veteran’s service connection claim must be denied. 2. Service connection for hepatitis C is denied. The Veteran seeks service connection for hepatitis C. The Veteran denied any illicit drug use during his June 1972 enlistment examination, and there were no identifying body marks, scars, or tattoos noted. His STRs are silent for any liver complaints, treatments, or diagnosis, including hepatitis C. When the Veteran was hospitalized for an upper respiratory infection during service in July 1972, the administrative diagnosis was “To Be Discharged From Service for EPTS Drug Abuse.” The July 1972 Report of Examination conducted just prior to separation was negative for liver disease, but noted a tattoo on the Veteran’s left forearm. On the July 1972 Report of Medical History, the examiner made a notation that the Veteran used marijuana, LSD, and THC, the specifics of which were unknown. The Veteran was subsequently recommended for immediate discharge (see July 1972 letter titled “Recommend Disposition for Preservice Drug Abusers”), and as noted, was separated from service 23 days after service entry. The Veteran indicates that he learned of his hepatitis C when his blood was drawn in the 1990’s, which was later confirmed by a liver needle biopsy. Disability benefits for chronic liver disease were awarded to the Veteran from the Social Security Administration in May 2010. The Veteran was afforded a VA examination in April 2011, and reported that he found out he had hepatitis C after routine blood work in 1992. The examiner noted the Veteran had been treated with interferon, and that there was no current virus detectable in his blood stream. The Veteran reported etching tattoos on himself with a sewing needle prior to military service, taking injectable Vistaril/Valium after service, being given blood transfusions after service, and recently using medical marijuana. He denied any high risk sexual behavior, sharing razors or toothbrushes, using intravenous cocaine, illegal drugs, or medication that affected his liver. However, the examiner noted the Veteran’s denial of the use of illicit drugs at the time of his enlistment examination, and his subsequent admission of a long history of drug use prior to service, and thus found the Veteran’s reliability as a historian to be questionable. The examiner further noted that during the present examination, the Veteran continued to deny his history of drug abuse as revealed in his service records, and only disclosed his recent use of medical marijuana. The examiner opined that the most likely cause of the Veteran’s hepatitis C was due to the risk factors of his long history of illegal drug use and his self-inscribed tattoos with a sewing needle. The examiner did not relate the Veteran’s hepatitis C to his military service. Based on the review of the lay and medical evidence, the Board finds that service connection for hepatitis C is not warranted. There is evidence of a current disability of hepatitic C; however, there is no competent link between his hepatitis C and his brief military service. The Board finds the April 2011 VA examination and medical opinion to be competent and highly probative as to the likely etiology of the Veteran’s hepatitis. The unfavorable opinion was factually accurate and based on a review of the entire claims file. The opinion was also accompanied by a detailed rationale. Moreover, there is no contrary competent opinion of record. The Veteran, as a layperson, is competent to attest to what he observes or senses. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he is not competent to diagnose hepatitis C or medically relate it to service, as he is not shown to possess the training and expertise to make these determinations. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Board finds that the Veteran’s lay statements as to etiology are inconsistent with, and outweighed by, the competent medical evidence of record. To the extent that the Veteran abused drugs during service, the Board notes that direct service connection may be granted only when a disability was incurred or aggravated in line of duty and not the result of a Veteran's own willful misconduct or, for claims filed after October 31, 1990, the result of his or her abuse of alcohol or drugs. See 38 C.F.R. § 3.301 (a) (2017). The law prohibits a grant of direct service connection for drug or alcohol abuse on the basis of incurrence or aggravation in the line of duty during service. Pub. L. No. 101-508, § 8052, 104 Stat. 1388, 1388-351 (1990); VAOPGCPREC 2-98 (Feb. 10, 1998), 63 Fed. Reg. 31263 (1998). However, a Veteran may be service connected for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, his service-connected disability. In order to qualify for service connection, the Veteran must establish, by clear medical evidence, that his alcohol or drug abuse disability is secondary to or is caused by their primary service-connected disorder, and that it is not due to willful wrongdoing. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Here, there is no basis to award service connection for hepatitis C based on any drug abuse during service, and secondary service connection is not applicable here. Based on the foregoing, service connection for hepatitis C must be denied. The Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran’s claim for service connection hepatitis C, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 3. Service connection for dental disability, claimed as dental injury due to an in-service personal assault, is denied. The Veteran seeks service connection for a dental condition, claimed as loss of teeth, which he contends occurred during a service-connected sexual assault, where his head was slammed forcefully into a wall, and resulted in a dental injury. See March 2015 Statement in Support of Claim. Disability compensation may be provided for certain specified types of service-connected dental disorders. For other types of service-connected dental disorders, the claimant may receive treatment only and not compensation. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. Dental disabilities that may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, loss of the maxilla, nonunion or malunion of the maxilla, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, and loss of teeth due to the loss of substance of the body of the maxilla or mandible without loss of continuity. 38 C.F.R. § 4.150, Diagnostic Codes (DCs) 9900-9916. Compensation is only available for loss of teeth, where the lost masticatory surface cannot be restored by suitable prosthesis, if such is due to loss of substance of body of maxilla or mandible, but only if such bone loss is due to trauma or osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, as such loss is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. STRs indicate that during the June 30, 1972 enlistment examination, the Veteran did not endorse tooth problems on the Report of Medical History. Furthermore, the examiner did not complete the dental charting on the Report of Medical Examination, and only marked “accept”. On the July 28, 1972 examination, conducted prior to separation, the Veteran endorsed “severe tooth or gum problems” on the Report of Medical History, and the examiner noted “tooth extraction on July 27, 1972.” On the Report of Medical Examination, the examiner indicated the Veteran was missing three wisdom teeth (#1, 16, and 32), two right first molars (#3 and 30), and had restorable dental caries in teeth (#6, 7, 8, 9, 14, 18, 19 and 31), noted as “dental defects,” and recommended dental correction. As noted, the Veteran was hospitalized on August 1, 1972 for pneumonia. Admission notes indicated “good dentition,” and the head, eyes, ears, nose and throat (HEENT) examination as “unremarkable, no petechia,” without comment regarding facial trauma. According to hospital admission notes, on July 28 the Veteran had two teeth extracted and was having “discomfort from the dental procedure.” STRs are silent for any further complaints, treatments, or dental procedures. During a post-service June 2011 VA dental consultation, the Veteran requested clearance before PFT, and complained of a loose right bridge, chipped #9 tooth, occasional jaw popping, jaw not opening as wide as it did previously, and halitosis caused by bacteria forming under his bridge. The Veteran expressed concerns that his interferon treatments for his hepatitis C made his bones and teeth brittle, which he believed was the reason for the #9 chip fracture. External examination revealed the Veteran’s mandible deviated to the left on opening. Internal examination indicated heavily resorted dentition. X-rays revealed slightly asymmetrical temporomandibular joints (TMJ). The assessment was gingivitis, heavily restored and stable dentition, and Ellis Classification I (enamel fracture) of the #9 tooth. The Veteran was cleared for PFT testing. The Veteran was afforded a VA dental examination in October 2016. Physical examination indicated there was no asymmetry of the muscles of mastication. The Veteran had full range of motion, and no pain on palpation or manipulation of the TMJs. There was no evidence of mandible or maxilla loss or bony injury, or loss of teeth due to anatomical loss or bony injury. The examiner opined that the Veteran’s dental condition was less likely as not incurred in or caused by the claimed in service-service personal assault. The examiner reasoned that the evidence did not support the Veteran’s statement of the events. The examiner indicated the Veteran was currently missing teeth #1, 3, 16, 17, 19, 30, 31, and 32. The July 1972 separation examination listed missing teeth #1, 3, 16, 30 and 32, as well as, restorable teeth #6, 7, 8, 9, 14, 18, 19, and 31. Teeth #1, 3, 16, 30, and 32 were missing prior to enlistment. Teeth #3 and 30 were extracted during childhood as evidenced by the mesial drift of adjacent teeth at the time he had bridges made, based on the width of the pontics to replace the teeth. Teeth #17 (wisdom tooth) and 19 were extracted during service after the July 28, 1972 separation examination, which is supported by the August 1, 1972 hospital admission notes where the Veteran reported that he had two teeth extracted. Bridges were made to replace teeth #3, 19, and 30 following discharge as a Dental Class II (categorized as routine dental care for recently discharged Veterans). The Veteran reported tooth #31 was extracted in prison. The examiner further noted that there was no evidence to support the Veteran’s report that all four wisdom teeth (#1, 16, 17, and 32) were extracted in 1974, since three of them were already missing in 1972, as noted on the separation examination. The examiner concluded it would be mere speculation to determine if tooth #19 was damaged during the assault as there was no documentation regarding the reason for the extraction. Moreover, the examiner found that June 30, 1972 enlistment examination not to be wholly accurate, as dental screenings during the examinations were not performed by dentists and done without dental radiographs, and were only used to determine if the recruit had significant dental problems that would make him unacceptable for enlistment. (The examiner further observed that the June 1972 enlistment examination did not document the tattoo on the Veteran’s left forearm, although as discussed above, the Veteran indicated that he put a tattoo on himself with a sewing needle prior to service). Although the Veteran received in-service extractions for teeth #17 (wisdom tooth) and #19, the medical records do not indicate the loss of teeth were due to trauma, as evidenced by the August 1972 hospital admission notes that revealed “good dentition” and a normal HEETN examination, with no documentation of facial trauma. The evidence of record does not show that the Veteran has a current dental disability due to loss of substance of body of maxilla or mandible through trauma or osteomyelitis. Nor is there evidence the Veteran sustained any damage to his maxilla or mandible, or suffered any other impairment involving the mandible, ramus, or maxilla, during service. Rather, the evidence reflects that the Veteran's tooth was extracted, and the October 2016 VA examiner found that it was not due to loss of substance of body of maxilla or mandible. Additionally, the tooth #19 was adequately replaced following discharge. The Board finds the October 2016 VA examination and medical opinion to be competent and highly probative as to the likely etiology of the Veteran’s dental disability. The opinion was factually accurate and based on a review of the entire claims file. The opinion was also accompanied by a detailed rationale. Moreover, there is no contrary competent opinion of record. The Veteran has not presented, and the remaining evidence of record does not otherwise contain, any competent evidence showing that the Veteran has a dental disability for which service connection for compensation purposes may be granted. The Veteran, as a layperson, is competent to attest to what he observes or senses. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Board finds that the Veteran’s lay statements as to etiology of his dental disability are inconsistent with, and outweighed by, the competent medical evidence of record. For these reasons, the Board finds that the claim for service connection for a dental disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence weighs against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to an earlier effective date for the award of service connection for PTSD is denied. The Veteran asserts that he warrants an earlier effective date for the award of service connection for PTSD. Specifically, in his May 2016 notice of disagreement, the Veteran’s attorney argues that an effective date should be granted as of August 2, 2010, the date the Veteran met with a VA social worker requesting information regarding benefits available to him. During the August 2010 VA social work assessment, the Veteran presented a vague request for information on benefits available to him. The Veteran indicated that he had already met with a homeless outreach program, as well as applied for Social Security Disability. The Veteran stated that he would be meeting with a Veteran’s service officer to inquire about his eligibility to receive VA compensation or pension. The social worker provided the Veteran with information giving an overview of VA healthcare eligibility, and directed him where to obtain a copy of a Federal benefits booklet. The Veteran filed a formal claim for service connection for reactive depression/PTSD on a VA Form 21-526b, Veteran’s Supplemental Claim, on February 9, 2011. The Veteran was granted service connection for PTSD in a March 2016 rating decision, with an effective date of February 9, 2011, the date of the formal claim. The Veteran asserts an earlier effective date on the basis that the August 2, 2010 meeting with the VA social worker constitutes an informal claim. Generally, the effective date of an award based on an original claim for benefits is based on the filing of a claim for such benefits. 38 U.S.C. § 5110; 38 C.F.R. § 3.151. See Wells v. Derwinski, 3 Vet. App. 307 (1992). Benefits are generally awarded based on the date of receipt of the claim. 38 C.F.R. § 3.1(r), 3.400. A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101 (a)(1); 38 C.F.R. § 3.151 (a). The term "claim" or "application" means 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). Any communication or action indicating an intent to apply for one or more benefits under laws administered by VA from a claimant may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155 (a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). For claims received on or after March 24, 2015, VA amended its regulations governing how to file a claim. The effect of the amendment was to standardize the process of filing claims, as well as the forms accepted, in order to increase the efficiency, accuracy, and timeliness of claims processing, and to eliminate the concept of informal claims. See 38 C.F.R. § 3.155; 79 Fed. Reg. 57660-01. However, prior to the effective date of the amendment, an informal claim may be any communication or action, indicating intent to apply for one or more benefits under VA law. See Thomas v. Principi, 16 Vet. App. 197 (2002); see also 38 C.F.R. §§ 3.1 (p), 3.155(a) (2017). An informal claim must be written, see Rodriguez v. West, 189 F. 3d. 1351 (Fed. Cir. 1999), and it must identify the benefit being sought. Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Upon review of the evidence of record, the Board finds no basis under the law to award an effective date earlier than February 9, 2011, the date of his original claim for service connection. There is no evidence manifesting the intent of the Veteran to file a claim for benefits for psychiatric disorder prior to his February 9, 2011, formal claim for this specific benefit. In concluding so, the Board finds that the that the August 2, 2010 social worker meeting note does not constitute an informal claim. Here, the 2010 VA social work note indicates the Veteran presented a “vague” request for information available to him, and does not establish the Veteran’s intent to seek a claim for benefits for PTSD. There is no evidence that the Veteran requested compensation benefits for a psychiatric disorder with VA at that time. As such, the Board finds the August 2, 2010 communication between the Veteran and the VA social worker does not constitute an informal claim for VA benefits. Accordingly, when the Veteran filed his claim in February 2011, there was no pending, unadjudicated claim for PTSD. Thus, there is no legal basis for the assignment of an earlier effective date. As such, an earlier effective date prior to February 9, 2011, for the award of service connection for PTSD is denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence weighs against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Entitlement to a TDIU is denied. According to the April 2016 Form 21-8940 TDIU applications, the Veteran asserts he is unemployable due to “PTSD/R-Dep/panic/anxiety.” VA received the Veteran’s claim for a TDIU on April 28, 2016. Total disability ratings for compensation based on individual unemployability may be assigned when the combined schedular rating for the service-connected disabilities is less than 100 percent and when it is found that the service-connected disabilities are sufficient to produce unemployability, without regard to advancing age, provided that, if there is only one such disability, this disability is ratable at 60 percent or more, or, if there are two or more disabilities, there is at least one disability ratable at 40 percent or more and additional disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a) (2017). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disability of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16. VA will grant a TDIU when the evidence shows that a Veteran is precluded, by reason of service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. In Faust v. West, 13 Vet. App. 342 (2000), the United States Court of Appeals for Veterans Claims (Court) defined “substantially gainful employment” as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the Veteran actually works and without regard to the Veteran’s earned annual income. Other factors to be considered in determining whether a Veteran is unemployable are his level of education, his employment history, and his vocational attainment. See Hyder v. Derwinski, 1 Vet. App. 221, 223 (1992). The ultimate question of whether a Veteran is capable of sustaining or obtaining a substantially gainful employment is an adjudicatory determination, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed.Cir.2013) (“[A]pplicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner”). Here, the Veteran’s sole service-connected disability is PTSD which is 70 percent disabling from February 9, 2011. Thus, for the rating period on appeal, the Veteran met the schedular criteria for a TDIU. The question that remains, however, is whether the Veteran’s service-connected disability precluded him from obtaining or engaging in substantially gainful employment. The central inquiry is, “whether the Veteran’s service-connected PTSD alone is sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). According to May 2010 disability determination from Social Security Administration, the Veteran was granted disability benefits unrelated to his service-connected PTSD. In a March 2012 Statement in Support of Claim, the Veteran stated that after discharge, he worked for General Motors, but began to suffer from depression due to his sexual assault in service, was hospitalized many times, and was finally put on permanent disability from General Motors. According to his April 2016 TDIU application, the Veteran worked for General Motors until 1985, and then went to prison from 1986 to 2009. He indicated that his education level was a “PhD in MDOC,” which appears to be in reference to the 25 years he spent in prison. The Veteran was afforded a VA mental disorders examination in April 2011. The Veteran was diagnosed with mood disorder, NOS, and cluster B personality traits disorder. The examiner opined that based on his history, the Veteran’s personality disorder likely had its onset prior to military service, and was only further reinforced by life circumstances, such as his extended incarceration. The examiner further opined that the Veteran could maintain employment, but his “personality organization” presented some challenges, thereby requiring continued structure and management. In a subsequent September 2012 VA addendum medical opinion, the examiner opined that there was no evidence that the Veteran suffered from any clinically significate mood disturbances during his brief military service, as evidenced by his “satisfactory” level of performance during his training exercises. Furthermore, the examiner opined that the Veteran’s early sexual and physical abuse contributed to the Veteran’s current maladaptive personality organizations, and that there was insufficient evidence that the Veteran’s cluster B personality traits disorder was by caused or a result of service, but rather the Veteran appeared to be struggling with adjustment issues and situational anxiety inherent to prolonged periods of incarceration. The Veteran was afforded a VA PTSD examination in September 2016, and a diagnosis of cluster B personality disorder was confirmed and an additional diagnosis of PTSD was assessed. The examiner determined the Veteran had total occupation impairment, however he noted that the Veteran’s behaviors were not of a person with PTSD, but of a person with a severely compromised paranoid and antisocial personality disorder. The examiner opined it was less likely as not that the Veteran’s functional impairment in an occupational environment was due to the Veteran’s service-connected PTSD, but was more likely a result of his cluster B personality traits disorder. Based on the evidence of record, both lay and medical, the Board concludes that, for the rating period on appeal, a TDIU is not warranted. Although the evidence establishes that the Veteran experiences some occupational impairment, the evidence does not establish that the impairment is due to his service-connected PTSD, but rather due to his non-service connected personality disorder. See September 2016 VA examination report. Indeed, the April 2011 and September 2012 VA examiner determined that the Veteran’s personality disorder did not have its onset during his brief time in service, but rather began prior to service, and was reinforced by the Veteran’s prolonged 25-year incarceration, and not his military service. Given all evidence of record, the Board finds that the Veteran’s service-connected PTSD does not preclude him from substantially gainful employment, and thus entitlement to a TDIU is not warranted. As a preponderance of the evidence is against the assignment of a TDIU, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. D. Logan, Associate Counsel