Citation Nr: 19103167 Decision Date: 01/11/19 Archive Date: 01/11/19 DOCKET NO. 16-55 269 DATE: January 11, 2019 ORDER Service connection for a left knee disorder is denied. Service connection for a right ankle disorder is denied. Service connection for bilateral hearing loss is denied. Service connection for acid reflux, including as due to a qualifying chronic disability to include undiagnosed illness, is denied. Service connection for asthma (claimed as chronic cough), including as due to a qualifying chronic disability to include undiagnosed illness, is denied. Service connection for headaches, including as due to a qualifying chronic disability to include undiagnosed illness, is denied. From July 9, 2012, an initial disability rating in excess of 10 percent for tinnitus is denied. From July 9, 2012, an initial disability rating of 50 percent, but no higher, for posttraumatic stress disorder (PTSD), is granted. REMANDED A total disability rating based on unemployability due to service-connected disabilities (TDIU) is remanded FINDINGS OF FACT 1. The Veteran does not have a current disability of the left knee or right ankle. 2. The Veteran does not have a current disability of bilateral hearing loss for VA disability compensation purposes. 3. The Veteran had service in the Southwest Asian Theater of operations during the Persian Gulf War. 4. The Veteran has current diagnoses of asthma and mild headaches. 5. The Veteran does not have a currently diagnosed acid reflux disorder. 6. A qualifying chronic disability of acid reflux, headaches, and asthma did not manifest during service in Southwest Asia, or to a compensable degree for any six-month period since service. 7. Symptoms of headaches were not chronic in service, not continuous since service separation, and did not manifest to a compensable degree within one year of service separation. 8. The Veteran did not have an in-service injury, disease, or event involving asthma or headaches, and the current asthma and headaches are not etiologically related to service. 9. For the entire initial rating period from July 9, 2012, the service-connected tinnitus has been assigned the maximum 10 percent schedular rating available under Diagnostic Code 6260. 10. For the initial rating period from July 9, 2012, the severity, frequency, and duration of the symptoms of the service-connected PTSD have more nearly approximated occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for service connection for a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326, 3.385. 4. The criteria for service connection for acid reflux, including as due to a qualifying chronic disability to include undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317, 4.115a, Diagnostic Code 7346. 5. The criteria for service connection for asthma (claimed as chronic cough), including as due to a qualifying chronic disability to include undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317, 4.97, Diagnostic Code 6602. 6. The criteria for service connection for headaches, including as due to a qualifying chronic disability to include undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317, 4.124a, Diagnostic Code 8100. 7. There is no legal basis for the assignment of a disability rating in excess of 10 percent for tinnitus for any period from July 9, 2012. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.87, Diagnostic Code 6260. 8. Resolving reasonable doubt in the Veteran’s favor, from July 9, 2012, the criteria for an initial disability rating of 50 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the Appellant, served on active duty from January 2005 to January 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2013 and January 2014 rating decisions from the Regional Office (RO), which, in pertinent part, granted service connection for PTSD and tinnitus, assigning 30 percent and 10 percent initial disability ratings, respectively, effective July 9, 2012, and denied service connection for a left knee disorder, right ankle disorder, bilateral hearing loss, chronic cough, acid reflux, and headaches. During the course of the appeal, in an August 2018 Rating Decision, the RO granted a “staged” 50 percent initial disability rating for PTSD from August 22, 2018. As the Veteran has not expressed satisfaction with the assigned ratings, the appeal for higher ratings remains before the Board. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board notes that in the May 2014 Notice of Disagreement (NOD), the Veteran expressed disagreement with the 30 percent initial rating assigned for PTSD, asserting a 50 percent initial rating is warranted. The Veteran did not express disagreement with the effective date for the grant of service connection for PTSD. The September 2016 statement of the case (SOC) characterized the issue as an appeal for a higher initial disability rating and discussed the appropriateness of the rating assigned. The August 2018 rating decision assigned a 50 percent staged rating from August 22, 2018, and discussed the appropriateness of the staged rating assigned. The Veteran submitted an November 2018 NOD and supplemental correspondence, requesting an earlier effective date for the 50 percent staged rating in addition to the highest rating possible, and characterized the issue on appeal as an entitlement to a higher initial rating and an earlier effective date than August 22, 2018 for the 50 percent rating for PTSD. Because the 50 percent staged rating stems from disagreement with the 30 percent initial disability rating assigned for the earlier stage of the initial rating appeal following the grant of service connection, the representative’s characterization of the issue as one for an earlier effective date does not constitute an actual effective date appeal. Neither the Veteran nor the representative expressed disagreement with the effective date of the grant of service connection, July 9, 2012, nor have they expressed that an effective date prior to the date of claim for service connection, July 9, 2012, is warranted, which is the only effective date that could have been appealed; any other disagreement with ratings for any stage of this increase rating appeal would necessarily have constituted disagreement with the initial rating assigned for that particular stage. See May 2014 NOD. The Veteran has only asserted disagreement with 30 percent stage of the rating assigned for the rating period from July 9, 2012 to August 22, 2018 and requested that the highest rating allowable be assigned during the initial rating period. Because a disability rating in excess of 30 percent from July 9, 2012 to August 22, 2018 has remained on appeal before the Board, and the Veteran’s main contention is that a higher rating of 50 percent is warranted from July 9, 2012 for the first staged rating period, the issue on appeal remains an initial rating appeal, and there is no actual earlier effective date appeal before the Board. Likewise, the representative’s use of the phrase “earlier effective date” has not raised an actual effective date issue. The issue remaining on appeal is entitlement to an initial disability rating for PTSD, in excess of 30 percent for the early stage of the rating period from July 9, 2012 (date of receipt of the claim for service) to August 22, 2018, and in excess of 50 percent from August 22, 2018 (the date a staged 50 percent rating was assigned). For these reasons, the Board will conduct its analysis of the staged 30 percent and 50 percent ratings of the initial rating appeal. While the representative later styled the appeal as one for an earlier effective date, there can be no prejudice to the Veteran because the substance of the statement of the case and rating decision adjudication was essentially a rating analysis for the early and later rating periods; the same evidence would be weighed and considered in the same manner to resolve either the question of when the evidence showed that entitlement to a higher disability rating arose (an effective date criterion) or the appropriateness of the rating for a particular stage of increase rating (increase rating question). The analysis and result would be the same under either an “entitlement arose” analysis or whether a higher rating is warranted for early stage analysis. During the pendency of the appeal for a higher initial disability rating for PTSD, the Veteran submitted evidence difficulty maintaining employment due to the service-connected disability that attached to the claim for a higher initial disability rating for PTSD for the rating period from July 9, 2012. November 2018 NOD and Correspondence. See Rice v. Shinseki, 22 Vet. App. 447, 453-4 (2009). As such, the TDIU rating period on appeal is from July 9, 2012, the effective date for PTSD. The Board need not address the duties to notify and assist regarding the issue of TDIU, as this issue is being remanded for further development. As to the remaining issues on appeal, the Board finds that the duties to notify and assist in this case have been fulfilled. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. The Veteran is currently diagnosed with headaches, which can be considered an “organic disease of the nervous system” recognized as a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309 apply to the claim for service connection for headaches. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran is also currently diagnosed with asthma, which is not listed as a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) do not apply as to this issue. Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). The Veteran must have served 90 days or more during a war period or after December 31, 1946 for the chronic presumptive provisions to attach. 38 C.F.R. § 3.307(a)(1). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a). Service connection may be granted on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on qualifying chronic disability, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Lay persons are competent to report objective signs of illness. The term “Persian Gulf veteran” means a veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The DD Form 214 and service treatment records reflect that the Veteran served in Southwest Asia from September 2005 to March 2006 and from March 2008 to August 2008; therefore, this Veteran is a Persian Gulf veteran as defined by 38 C.F.R. § 3.317. A “qualifying chronic disability” for VA purposes is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or IBS) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; and (12) abnormal weight loss. 38 C.F.R. § 3.317(b). 1. Service Connection for a Left Knee Disorder 2. Service Connection for a Right Ankle Disorder The Veteran generally contends that service connection for a left knee and right ankle disorder is warranted. Specifically, the Veteran contends that he worked long hours standing at entry point gates and patrolling flight lines during service, which required him to stand for several hours while wearing heavy gear and caused strain on the knees and ankles. See October 2012 lay statement. The requirement of a current disability is satisfied when a veteran has a disability at the time he files a service connection claim, during the pendency of that claim, or just prior to the filing of a claim, even if the disability resolves prior to adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that the Veteran has current left knee and right ankle disabilities. Service treatment records reflect one episode of right ankle discomfort after walking on rough terrain in February 2006, but are silent as to symptoms, diagnosis, or treatment of any left knee disorder. Subsequent service treatment records reflect no mention of left knee or right ankle pain; the Veteran specifically denied problems with swollen, stiff, or painful joints; and clinical examination of the lower extremities was normal. See August 2006, August 2008, May 2009, December 2010 service treatment records. Post-service treatment notes also reflect no diagnoses or treatment for left knee or right ankle disorders. Although the Veteran reported bilateral knee pain in April 2016, clinical evaluation in May 2014 and April 2016 revealed normal active and passive range of motion without effusions or gross deformities. See May 2014, April 2016 VA treatment records. Pain alone without evidence of functional impairment is not sufficient to support a finding of a current left knee or right ankle “disability.” See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018) (holding that pain can qualify as a disability where there is evidence of functional impairment of earning capacity). Additionally, the VA examiner in March 2013 assessed no diagnosis of a left knee or right ankle disability, as there was left knee flexion to 140 degrees and extension to 0 degrees (normal) and right ankle plantar flexion to 45 degrees and dorsiflexion to 20 degrees (normal) without evidence of painful motion. Additionally, imaging of the left knee and right ankle was normal. See March 2013 VA examination report. In summary, the evidence does not show the Veteran has been diagnosed with a left knee or right ankle disability at any time during the pendency of this claim or in the time period just prior to the filing of this claim. In the absence of proof of a current disability, there can be no valid claim for entitlement to service connection for a left knee or right ankle disorder on either a direct, secondary, or any other basis. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for service connection for a left knee and right ankle disorder, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service Connection for Bilateral Hearing Loss The Veteran generally contends that service connection is warranted for bilateral hearing loss due to exposure to loud noise from police sirens and working on the flight line during active service. See October 2012 lay statement. For VA purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater; the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, the U.S. Court of Appeals for Veterans’ Claims (Court) has held that “the threshold for normal hearing is from 0 to 20 dBs [decibels], and higher threshold levels indicate some degree of hearing loss.” See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). After a review of all the evidence of record, lay and medical, the Board finds that the weight of the evidence shows the Veteran does not have a current hearing loss disability as defined by VA regulatory criteria under 38 C.F.R. § 3.385. In January 2014, the Veteran was provided a VA audiometric examination. During the January 2014 VA audiometric examination, pure tone thresholds, in decibels, were recorded as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 10 15 10 LEFT 10 10 15 15 10 Speech recognition scores using the Maryland CNC Test revealed speech discrimination of 94 percent bilaterally. Upon conclusion of the January 2014 VA examination, the VA examiner diagnosed normal hearing in both ears. See January 2014 VA examination report. Overall, the evidence of record shows that the Veteran has normal hearing, i.e., 0 to 20 dB, in both ears and does not show a current hearing loss disability at the 500 to 4000 Hz ranges as defined by 38 C.F.R. § 3.385. Because a hearing loss disability as defined by the VA regulatory criteria at 38 C.F.R. § 3.385 is not demonstrated in this case, service connection must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Service Connection for Acid Reflux 5. Service Connection for Asthma (claimed as Chronic Cough) 6. Service Connection for Headaches The Veteran generally contends that service connection is warranted for chronic cough, headaches, and acid reflux due to service in Kuwait and Qatar during the Persian Gulf War. See October 2012 Lay Statement, November 2016 VA Form 9. First, The Board finds that the Veteran has current diagnoses of asthma (claimed as chronic cough) and headaches, as reflected in the March 2013 VA examination report. The Board finds that the weight of the evidence is against finding that the Veteran has a current acid reflux disorder. A March 2013 VA examination reports that the Veteran did not presently have and had never been diagnosed with any esophageal conditions, to include acid reflux and gastroesophageal reflux disease (GERD). The Veteran reported occasional heartburn that resolved with Tums but had no history of treatment, diagnostic testing, hospitalization or surgery for an esophageal condition. Moreover, the VA examiner assessed no signs, symptoms, or treatment with continuous medication for an esophageal condition on examination. See March 2013 VA examination report. VA treatment records associated with the appeal are silent as to any complaints, treatment, or diagnosis of acid reflux or any other esophageal or gastrointestinal disorders. Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. §§ 1110. “In the absence of proof of a present disability there can be no valid claim.” See Brammer, 3 Vet. App. at 225; McClain, 21 Vet. App. 319 (holding that service connection can also be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky, 26 Vet. App. 289 (holding that a current disability may include a diagnosis at the time the claim was filed or during its pendency). The Board finds that the weight of the evidence in this case is against finding an acid reflux disorder at any point during the claim period or even prior to the filing of the claim for service connection. See Waters v. Shinseki, 601 F.3d 1274, 1277 (Fed. Cir. 2010) (stating that there must be “medically competent” evidence of a current disability). The VA examination report provides rationale as to why current diagnosis is not warranted and the VA treatment records are absent evidence of symptoms, diagnosis, or treatment for acid reflux. Further, while the Veteran is competent to report symptoms of acid reflux, he does not have the requisite medical knowledge, training, or experience to be able to diagnose an acid reflux disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Digestive disorders are medically complex because of the multiple potential etiologies, can require specialized testing to diagnose, and observable symptomatology can overlap with other disorders. Diagnosing digestive disorders, including those manifest by acid reflux, involves internal and unseen system processes unobservable by the Veteran. The Veteran has not been shown to have such knowledge, training, or experience. However, as noted above, because the Veteran is a Persian Gulf veteran, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 apply. Signs and symptoms listed that may be manifestations of undiagnosed illness include signs or symptoms of gastrointestinal and respiratory problems, as well as headaches. The Board finds that service connection is not warranted for acid reflux, asthma (claimed as chronic cough), or headaches under the Persian Gulf War presumption. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. After a review of all the lay and medical evidence of record, the Board finds that a qualified chronic disability characterized by acid reflux, chronic cough, and headaches did not manifest during service in Southwest Asia. With regard to symptoms of heartburn, which the Veteran has characterized as acid reflux, the service treatment records, which appear complete, are silent as to any mention of problems with heartburn or acid reflux. Service treatment records reflect treatment for an acute upper respiratory infection in July 2006 associated with vomiting, cough, and congestion, for which the Veteran was quartered for 24 hours. Between 2007 and 2008, there was treatment for three episodes of acute gastroenteritis with associated nausea, vomiting, and diarrhea after food consumption. See July 2006, February 2007, June 2008, July 208 service treatment records. However, service treatment records are absent any complaints, diagnosis, or treatment of heart burn or acid reflux during service. In August 2006 and March 2009, the Veteran denied current problems or a history of problems with frequent indigestion, stomach or intestinal trouble and rectal disease. Moreover, there is no mention of problems with acid reflux during the December 2010 service separation examination. August 2006, May 2009, December 2010 service treatment records. The absence of any in-service reports of complaints, findings, diagnosis, or reference to treatment related to heartburn or acid reflux during service, under the facts of this case, is one factor, among other factors considered by the Board, including lay reports and treatment for gastroenteritis with nausea, vomiting, and diarrhea during service without mention of problems with heartburn or acid reflux, and contemporaneous denials of problems with indigestion during service. Given reports and treatment of other digestive problems during service, the presence of problems with heart burn or acid reflux likely would have been reported had they occurred. Additionally, post-service subjective reports of heartburn do not surface until 2013, years after service separation, with no mention of symptoms of acid reflux during service. Post-service treatment records also reflect no complaints, diagnosis, or treatment for acid reflux or heart burn and contemporaneous histories do not mentions problem with acid reflux during or since service. See March 2013 VA examination report, see generally VA treatment records. Such evidence weighs against finding an in-service manifestation of acid reflux or heart burn. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the absence of a notation in a record may only be considered if it is first shown that the record is complete and also that the fact would have been recorded had it occurred); Kahana v. Shinseki, 24 Vet. App 428, 438 (2011) (stating that VA may use silence in service treatment records as evidence contradictory to a veteran’s assertions if the service treatment records appear to be complete and injury, disease, or symptoms would ordinarily have been recorded had they occurred; Cf. AZ v. Shinseki, 731 F.3d 1303, 1315-18 (Fed. Cir. 2013) (recognizing and applying the rule that the absence of a notation in a record may be considered if it is first shown that the record is complete and also that the fact would have been recorded had it occurred, although holding that a veteran’s failure to report an in-service sexual assault to military authorities may not be considered as relevant evidence tending to prove that a sexual assault did not occur because military sexual trauma is not a fact that is normally reported); see also Fed. R. Evid. 803(7) (indicating that the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded). As for the claims for chronic cough and headaches, the evidence also weighs against finding an in-service manifestation of chronic cough and headaches during service in Southwest Asia. A history of respiratory problems was reported prior to service entrance. The service enlistment examination reports note a history of reactive airway disease prior to service entrance as the Veteran had two episodes of wheezing at age 7 and 18 that required treatment with inhalers and/or nebulizer for 6 months; however, pulmonary function tests were normal without evidence of airway obstruction at service entrance. See June 2003, July 2004, August 2003. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Service treatment records reflect one episode of an acute upper respiratory infection with associated cough and congestion in July 2006 that resolved; however, service records are silent as to complaints, diagnosis, or treatment for chronic cough or asthma during service. Likewise, service treatment records reflect no evidence of symptoms, diagnosis, or treatment for headaches during service. Post deployment screenings dated August 2006 and August 2008 reflect the Veteran’s lay statements denying problems with chronic cough and headaches, endorsing “good” and “excellent” health, and denying any physical difficulties over the last month. Moreover, the Veteran continued to deny current problems or a history of severe or frequent headaches, asthma, breathing problems, bronchitis, wheezing, chronic cough, shortness of breath, or use of inhalers in 2009 and made no mention of problems with chronic cough or headache during the service separation examination in December 2010. See May 2009, December 2010 service treatment records. As such, the Board finds that the preponderance of the evidence weighs against a finding that a qualified chronic disability characterized by a respiratory disorder and headaches manifested during service in Southwest Asia. The Board also finds that the subjective symptoms of acid reflux, chronic cough, and headaches have not manifested to a compensable degree (10 percent or more) during a six-month period since service. 38 C.F.R. § 3.317 (a)(1)(i). Regarding acid reflux, which the Veteran has described as occasional heart burn, the Board finds that this disorder is most closely analogous to hiatal hernia under 38 C.F.R. § 4.114, Diagnostic Code 7346. Under Diagnostic Code 7346, a 10 percent rating is assigned with two or more symptoms of the 30 percent evaluation of less severity. A 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. While the Veteran reported at the March 2013 VA examination that he experienced occasional heart burn, i.e., pyrosis, that resolves with Tums, the Veteran has reported no other symptoms associated with the claimed acid reflux, to include dysphagia and regurgitation. The Veteran specifically denied nausea, vomiting, abdominal pain, hematemesis, and the March 2013 VA examiner assess no signs or symptoms of an esophageal disorder. See March 2013 VA examination reports. Moreover, VA treatment records are silent as to symptoms, diagnosis, or treatment for acid reflux. As such, the record does not reflect that acid reflux has approximated as at least two or more symptoms of the 30 percent rating (i.e., dysphagia, pyrosis, and regurgitation) of less severity, a compensable (10 percent) rating under Diagnostic Code 7346 is not approximated. 38 C.F.R. § 4.114 Asthma (claimed as chronic cough) is rated under 38 C.F.R. § 4.97, Diagnostic Code 6602. Under Diagnostic Code 6602, a 10 percent rating is assigned for FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy. VA treatment records reflect no symptoms, diagnosis, or treatment for asthma or other respiratory problems, and the Veteran’s lungs were noted to be clear to auscultation bilaterally with good filling at the base. See May 2014 VA treatment record. During the March 2013 VA examination, the Veteran denied symptoms of cough wheezing or sob, and the VA examiner assessed no evidence of treatment for a respiratory disorder. See March 2013 VA examination report. As the post-service treatment records reflect no complaints of respiratory problems, no pulmonary function test, and no treatment for asthma, the evidence does not support a finding that asthma has approximated a FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy, as required for a compensable (10 percent) rating. 38 C.F.R. § 4.97, Diagnostic Code 6602. Headaches/migraines are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under Diagnostic Code 8100, a compensable (10 percent) disability rating is assigned for migraines with characteristic prostrating attacks averaging one in two months over the last several months. VA treatment records are silent as to symptoms, diagnosis, or treatment for headaches and examination revealed normal neurological findings post-service. See May 2014. During the March 2013 VA examination report, the Veteran reported mild, non-throbbing headaches localized to both sides of the head without associated nausea, vomiting, or light sensitivity. The Veteran denied any medications or treatment for headaches and reported that the last headache episode was more than one year ago. The VA examiner assessed no evidence of characteristic prostrating attacks of headaches. See March 2013 VA examination report. In light post-service treatment notes showing no symptoms or treatment for headaches, and the Veteran’s lay statement that headaches occur more than one year apart, the evidence does not support a finding that the mild headaches have approximated characteristic prostrating attacks averaging one in two months over the last several months to warrant a compensable (10 percent) rating. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. While headaches may also be considered for the “chronic disease” presumption, the Board finds that the mild headaches were not chronic in service, were not continuous since service, and did not manifest to a compensable degree within one year of service separation. 38 C.F.R. §§ 3.303(b), 3.307, 3.309. As previously reported, the service treatment records are silent as the symptoms, diagnosis, and treatment for headaches; the Veteran specifically denied problems with severe or frequent headaches during service; and there was no mention of problems with headaches during the service separation examination. See August 2006, May 2009, December 2010 service treatment records. Post-service treatment records reflect no complaints or treatment for headaches, to include contemporaneous lay histories of headaches since service. The first lay report of problems with mild headaches does not appear until the March 2013 VA examination, two years after service separation. As such, the preponderance of the evidence is against a finding that headaches were chronic in service, continuous since service, or manifested to a compensable degree within one year of service. As for direct service connection, the Board finds that the weight of the lay and medical evidence is against a finding that asthma (chronic cough) and headaches were incurred in or etiologically related to service. The service treatment records show contemporaneous denials of problems, with asthma, chronic cough, shortness of breath, and headaches during service. See August 2006, May 2009 service treatment records. VA headache and respiratory exams were provided in March 2013. The VA examiner opined that it was less than likely that asthma (claimed as chronic cough) and headaches were incurred in service. The VA examiner explained that the evidence showed a history of reactive airways disease prior to service with normal pulmonary function test prior to service entrance. Moreover, service treatment records showed only treatment for an acute upper respiratory infection in July 2006 that resolved, but otherwise no complaints or treatment for chronic cough, asthma, or headaches. As such, the VA examiner reasoned that it was less than likely that any current asthma and headaches were related to service, to include a specific exposure event during service in Southwest Asia. The Board finds the VA examiner’s opinion to probative in light of the evidence as a whole, which reflects no complaints, diagnosis, or treatment of chronic cough/asthma and headaches during service or since service separation, and no post-service contemporaneous lay histories of respiratory problems and headaches since service. For the reasons discussed above, the Board finds that the weight of competent and credible evidence demonstrates no current diagnosed acid reflux disability, no current qualifying chronic disability characterized by symptoms of acid reflux, asthma, or headaches that have manifested to a compensable degree during a six-month period since service, and no relationship between the Veteran’s current asthma and mild headaches and active service. As the preponderance of the evidence is against the claim for service connection on a direct, presumptive, or any other basis, the benefit of the doubt doctrine is not for application, and the claims for service connection for acid reflux, asthma (chronic cough), and headaches must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran has appealed from the initial rating assigned for tinnitus and PTSD. In an appeal for a higher initial rating after a grant of service connection, all evidence submitted in support of a veteran’s claim is to be considered. Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. 38 C.F.R. § 4.2; Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). The Board does not find staged ratings to be warranted in this appeal. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). 7. Rating Tinnitus from July 9, 2012 The Veteran generally contends that a higher initial rating is warranted for the service-connected tinnitus. See October 2014 Notice of Disagreement. The service-connected tinnitus is assigned a 10 percent initial disability rating for the entire initial rating period from July 9, 2012 under Diagnostic Code 6260. 38 C.F.R. § 4.87. Tinnitus is rated under Diagnostic 6260, which provides a 10 percent maximum disability rating for recurrent tinnitus. 38 C.F.R. § 4.87. Note (2) further explains that the Board must assign only a single rating for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head. The United States Court of Appeals for the Federal Circuit (Federal Circuit) affirmed VA’s long-standing interpretation of Diagnostic Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Citing United States Supreme Court precedent, the Federal Circuit explained in Smith that an agency’s interpretation of its own regulations was entitled to substantial deference by the courts as long as that interpretation was not plainly erroneous or inconsistent with the regulations. Finding that there was a lack of evidence in the record suggesting that VA’s interpretation of Diagnostic Code 6260 was plainly erroneous or inconsistent with regulations, the Federal Circuit concluded that the United States Court of Appeals for Veterans Claims had erred in not deferring to VA’s interpretation. In view of the foregoing, the Board concludes that the regulations preclude a schedular rating in excess of a single 10 percent rating for tinnitus; therefore, the Veteran’s claim for a disability rating greater than 10 percent for tinnitus must be denied under Diagnostic Code 6260, Note 2. 38 C.F.R. § 4.87. As disposition of this issue is based on the law and not the facts of the case, the issue must be denied based on a lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 8. Rating PTSD from July 9, 2012 A 30 percent rating is assigned for PTSD from July 9, 2012 to August 22, 2018, and a 50 percent rating is assigned from August 22, 2018 under 38 C.F.R. § 4.130, Diagnostic Code 9411. Pertinent to this case, the General Rating Formula for Mental Disorders provides that a 30 percent rating is assigned 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 will be assigned for a mental disability which is productive of occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks occurring 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 or 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. Id. A 70 percent rating will be assigned for 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; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 will be assigned for total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an 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. In this decision, the Board considered the rating criteria in the General Rating Formula for Mental Disorders not as an exhaustive list of symptoms, but as examples of the type and degree of the symptoms, or effects, that would justify a particular rating. The Board has considered the symptoms indicated in the rating criteria as examples of symptoms “like or similar to” the Veteran’s PTSD symptoms in determining the appropriate schedular rating assignment, and has not required the presence of a specified quantity of symptoms in the Rating Schedule to warrant the assigned rating for major depressive disorder. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and a veteran’s capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). The Secretary of VA, acting within his authority to adopt and apply a schedule of ratings, chose to create one general rating formula for mental disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501 (2012); 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 psychiatric disorders, there can be no doubt that the Secretary of VA anticipated that any list of symptoms justifying a particular rating would in many situations be either under- or over-inclusive. The Secretary’s use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. This construction is not inconsistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan, 16 Vet. App. at 442. The evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. The schedular rating criteria rate by analogy psychiatric symptoms that are “like or similar to” those explicitly listed in the schedular rating criteria. Mauerhan at 443. The Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the Federal Circuit held that VA “intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms.” The Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” In Golden v. Shulkin, No. 16-1208 (U.S. Vet. App. April 19, 2017), the Court held that, given that the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) abandoned the Global Assessment of Functioning (GAF) scale and that VA has formally adopted the DSM-5, GAF scores are inapplicable to assign a psychiatric rating in cases where the DSM-5 applies when the appeal was certified after August 4, 2014. Because of the Court’s emphatic pronouncement in Golden that the GAF scores are methodologically flawed and are particularly unreliable as applied to an acquired psychiatric disorder, in this decision, the Board will place no reliance on GAF scores for rating this Veteran’s PTSD. After a review of all the evidence, both lay and medical, the Board finds that for the entire rating period from July 9, 2012 to present PTSD has approximated occupational and social impairment with reduced reliability and productivity, which warrants a higher 50 percent rating under Diagnostic Code 9411. 38 C.F.R. § 4.130. A March 2013 VA examination reports that the Veteran was more distant with his family, had some conflicts with his girlfriend, and that he was socially avoidant and had driven friends away due to irritability; however, he engaged in some social activities such as going to dinner and the movies with his girlfriend. The Veteran had two physical altercations since leaving service but no arrests or other legal problems. Additionally, the Veteran was doing well in college studying criminal justice. The VA examiner assessed occupational and social impairment with decrease in work efficiency and associated symptoms of chronic sleep impairment, difficulty establishing and maintaining effective work and social relationships, and avoidance of crowds due to anxiety. VA treatment records are silent as to complaints or treatment for PTSD during the relevant rating period. In May 2014 treatment notes reflect incidental reports that the Veteran was projected to finish his bachelor degree in criminal justice with a certification in anti-money laundering within three months. The Veteran appeared pleasant with congruent mood and affect, no appearance of depression, and no evidence of suicidal ideation or homicidal ideation. In April 2016, the Veteran reported rare nightmares or flashbacks and no suicidal or homicidal ideation. Additionally, he declined therapy or medication management of PTSD as his symptoms had improved over time since service. See May 2014, April 2016 VA treatment records. The August 2018 VA examination reflects some improvement in social relationships, as the Veteran endorsed a positive rapport with his mom, spending time with close friends once a week, and attending social activities with his wife’s friends once to twice a month, although he indicated that his marriage was headed for divorce due to his drug use. The Veteran reported that he completed his bachelor’s degree, but had jumped from job to job approximately every one-and-a-half year due to feeling bored, unchallenged, and irritated. The Veteran reported quitting a job in November 2017 after his supervisor lectured him on his performance; however, he has remained employed since February 2018. The Veteran continued to report no history of treatment or interest in treatment or medications, as he reported improvement in symptoms with the passage of time. While symptoms of rare nightmares/flashbacks, depressed mood, anxiety, chronic sleep impairment, mild memory loss, flattened affect, disturbance of motivation, difficulty establishing and maintaining work and social relationships, and difficulty adapting to stressful circumstance were noted, the Veteran denied any behavioral or legal problems. Upon mental status examination, the VA examiner assessed dysthymic mood, but noted that the Veteran was oriented, neatly groomed, and polite and cooperative with adequate judgment and insight and no evidence of suicidal or homicidal ideation, delusions, or hallucinations. The August 2018 VA examiner assessed occupational and social impairment with reduced reliability and productivity. See August 2018 VA examination report. The record reflects that PTSD has manifested as symptoms of some difficulty establishing and maintaining relationships, disturbance of mood and motivation, anxiety, irritability and flattened affect, chronic sleep impairment, mild memory loss and rare nightmares. The Veteran has also reported two physical altercations since service separation during the March 2013 VA examination, but denied any additional behavioral or legal problems since then. As such the report of two physical altercations is like or similar to impaired judgment. Additionally, the Veteran has endorsed moving from job to job after approximately a year and a half due to boredom, feeling unchallenged, and irritability, which is like or similar reduced reliability and productivity and disturbance of mood and motivation; however, he did well in college and was able to successfully complete a bachelor’s degree in criminal justice with a certification in anti-money laundering, and he remains employed and noted that his current job is going “good” so far. See August 2018 VA examination report. Overall, since July 9, 2012, the record suggests that symptoms of PTSD have generally manifested as disturbance of mood and motivation, difficulty establishing and maintaining relationships, impaired judgement, irritability, anxiety, depression, flat effect, chronic sleep impairment and rare flashbacks and nightmares, which approximates occupational and social impairment with reduced reliability and productive, as require for a higher 50 percent initial rating. While the March 2013 VA examiner assessed occupational and social impairment with occasional decrease in work efficiency, the Board gives this opinion little weight, as the ultimate determination as to the level of occupational and social impairment is an adjudicative determination. The Board finds that, for the initial rating period from July 9, 2012, PTSD has not approximated the criteria for a higher 70 percent rating, that is, occupational and social impairment with deficiencies in most areas. Although the VA examiner in August 2018 noted symptoms of difficulty adapting to stressful circumstances, the Veteran has not required any therapy or treatment for symptoms and has endorsed improved symptoms with time. Moreover, the record reflects PTSD has primarily manifested as symptoms of disturbance of mood, difficulty establishing and maintaining relationships, impaired judgment, irritability, anxiety, depression, chronic sleep impairment flattened affect, and mild memory loss, which, considered as a whole, is consistent with occupational and social impairment with reduced reliability and productivity, as reflected by 50 percent rating assigned. Although, the Veteran reported two physical altercations since service during March 2013 VA examination, the Veteran denied any additional behavioral or legal problems over the next five years during the August 2018 VA examination. As such, the report of two physical altercations is like or similar to impaired judgement, consistent with the 50 percent rating assigned and is not like or similar to impaired impulse control such as unprovoked irritability with periods of violence. Despite some difficulties with relationships due to irritability, the Veteran maintains good rapport with his family, was able to attend dinner and movies with his girlfriend, and spent time with his close friend weekly; therefore, the record does not reflect an inability to establish effective relationships, as required for a higher 70 percent rating. Additionally, the record reflects no evidence suicidal or homicidal ideation; obsessive rituals; intermittently illogical, obscure, or irrelevant speech; near continuous panic or depression; special disorientation; or neglect of personal appearance and hygiene. For these reasons, the Board finds that, for the rating period from July 9, 2012 to present, the Veteran’s disability picture more nearly approximates the criteria for a 50 percent rating, but no higher, that is, occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. §§ 4.3, 4.7, 4.13, Diagnostic Code 9411. 9. Extraschedular Referral Consideration The Board has considered whether the Veteran or the record has raised the question of referral for an extraschedular rating adjudication under 38 C.F.R. § 3.321(b) for any period for the initial rating issue on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008). After review of the lay and medical evidence of record, the Board finds that the question of an extraschedular rating has not been made by the Veteran or raised by the record as to the issue on appeal. See Doucette v. Shulkin, 28 Vet. App. 366 (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); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. Appx. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not “specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted”). REASONS FOR REMAND 1. Entitlement to a TDIU is remanded. A claim for a TDIU is part of a rating issue when such claim is raised by the record or the Veteran during the rating period. Rice v. Shinseki, 22 Vet. App. 447 (2009). The service-connected disabilities are PTSD (50 percent disabling), right knee strain (10 percent disabling), residuals of left ankle sprain (10 percent disabling), and tinnitus (10 percent disabling). In a November 2018 correspondence, the Veteran submitted evidence and arguments that he has been unable to maintain work due to the service-connected disabilities. The Board finds that the evidence has reasonably raised a claim for a TDIU in conjunction with the increased rating issues decided herein; however, a remand is required prior to adjudication of the claim for a TDIU for the Agency of Original Jurisdiction (AOJ) to adjudicate TDIU in the first instance. The matters are REMANDED for the following action: 1. The AOJ should send the Veteran VCAA notice that addresses a claim for a TDIU. 2. Send the Veteran an Individual Unemployability form (VA Form 21-8940). The specific information in that form is requested from the Veteran; the Veteran should complete and return this form. Failure to fully complete this form may result in denial of the TDIU claim. See 38 C.F.R. § 3.158(a). 3. After all available evidence has been associated with the record, the AOJ should review the evidence and determine if further development is warranted for TDIU. The AOJ should take any additional development as deemed necessary.   4. After all development has been completed, the AOJ should adjudicate the issue of entitlement to a TDIU based on the evidence of record. If any aspect of the appeal remains denied, provide the Veteran and representative with a supplemental statement of the case. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Moore, Associate Counsel