Citation Nr: 19147802 Decision Date: 06/19/19 Archive Date: 06/19/19 DOCKET NO. 17-48 858 DATE: June 19, 2019 ORDER The petition to reopen of the claim of entitlement to service connection for a heart disorder is denied. The petition to reopen of the claim of entitlement to service connection for sleep apnea is denied. Entitlement to service connection for hypertension is denied. Entitlement to a disability rating in excess of 70 percent for service-connected psychiatric disability is denied. Entitlement to a disability rating in excess of 50 percent for service-connected headaches is denied. Entitlement to a disability rating in excess of 10 percent for service-connected tinnitus is denied. Entitlement to a disability rating in excess of 10 percent for service-connected right knee disability is denied. Entitlement to a disability rating in excess of 10 percent for service-connected left knee disability is denied. Entitlement to a disability rating in excess of 10 percent for service-connected thoracolumbar spine disability is denied. Entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 70 percent for the service-connected psychiatric disability, is denied. Entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 50 percent for the service-connected headaches, is denied. Entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 10 percent for the service-connected tinnitus, is denied. FINDINGS OF FACT 1. In a November 2013 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied reopening of a claim of entitlement to service connection for a heart disorder; the evidence of record at the time of the November 2013 decision established a history of mitral valve prolapse, but did not establish any other elements necessary for service connection. 2. The evidence received since the November 2013 decision does not relate to any unestablished fact that was necessary to substantiate the claim of entitlement to service connection for a heart disorder at the time of the November 2013 decision. 3. In a November 2013 rating decision, the RO denied a claim of entitlement to service connection for sleep apnea; the evidence of record at the time of the November 2013 decision noted a history of sleep apnea with use of continuous positive airway pressure (CPAP), but did not substantiate any other element necessary for service connection. 4. The evidence received since the November 2013 decision does not relate to any unestablished fact that was necessary to substantiate the claim of entitlement to service connection for sleep apnea at the time of the November 2013 rating decision. 5. Hypertension is not related to service. 6. The service-connected psychiatric disability has been manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 7. The Veteran has headaches which have a maximum rating of 50 percent. 8. The Veteran has tinnitus which has a maximum rating of 10 percent. 9. The service-connected right knee disability has been manifested by painful motion with flexion possible to at least 120 degrees, with full extension, and without lateral instability, meniscal pathology, or recurrent subluxation. 10. The service-connected left knee disability has been manifested by painful motion with flexion possible to at least 130 degrees, with full extension, and without lateral instability, meniscal pathology, or recurrent subluxation. 11. The service-connected thoracolumbar spine disability has been manifested by painful motion with thoracolumbar spine flexion to at least 80 degrees and with combined range of motion to at least 210 degrees. 12. The earliest date of a pending claim of entitlement to an increased rating for the service-connected psychiatric disability is April 30, 2015; the date of increase was later than the date of claim. 13. The earliest date of a pending claim of entitlement to an increased rating for the service-connected headaches is April 30, 2015; the date of increase was later than the date of claim. 14. The earliest date of a pending claim of entitlement to service connection for tinnitus is April 30, 2015. CONCLUSIONS OF LAW 1. The November 2013 RO rating decision is final with respect to entitlement to service connection for a heart disorder. 38 U.S.C. § 7105 (2012). 2. The criteria for reopening the claim of entitlement to service connection for a heart disorder have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2018). 3. The November 2013 RO rating decision is final with respect to entitlement to service connection for sleep apnea. 38 U.S.C. § 7105 (2012). 4. The criteria for reopening the claim of entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2018). 5. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for entitlement to a disability rating in excess of 70 percent for the service-connected psychiatric disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411 (2018). 7. The claim of entitlement to a disability rating in excess of 50 percent for the service-connected headaches lacks legal merit. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.124a, Diagnostic Code 8100 (2018). 8. The claim of entitlement to a disability rating in excess of 10 percent for the service-connected tinnitus lacks legal merit. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.85, Diagnostic Code 6260 (2018). 9. The criteria for a disability rating higher than 10 percent for the service-connected right knee disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5024 (2018). 10. The criteria for a disability rating higher than 10 percent for the service-connected left knee disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5024 (2018). 11. The criteria for a disability rating higher than 10 percent for the service-connected thoracolumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2018). 12. The criteria for entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 70 percent for the service-connected psychiatric disability have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.151, 3.400 (2018). 13. The criteria for entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 50 percent for the service-connected headaches have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.151, 3.400 (2018). 14. The criteria for entitlement to an effective date earlier than April 30, 2015, for the assignment of a rating of 10 percent for the service-connected tinnitus have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.151, 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Appellant is a veteran (the Veteran) who had active duty service from January 2004 to January 2007. This appeal comes before the Board of Veterans’ Appeals (Board) from an August 2015 rating decision of the VA RO in Waco, Texas. The Board acknowledges that the appeal originally encompassed a claim of entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) as a component of the increased rating claims in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009). However, that claim was granted in February 2019 and the effective date assigned was April 30, 2015, which is the date of claim for the increased rating claims on appeal. Accordingly, the full benefit sought on appeal has been awarded. Service Connection—Law and Regulations VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131. Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection on a secondary basis requires (1) evidence of a current nonservice-connected disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability caused or aggravated the current nonservice-connected disability. 38 C.F.R. § 3.310(a),(b); Wallin v. West, 11 Vet. App. 509, 512 (1998). For specific enumerated diseases designated as “chronic” there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service. In order for the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Presumptive service connection for chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3 (2018). A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a heart disorder and sleep apnea. On January 26, 2010, the Veteran filed an informal claim for service connection for a heart disorder. In a May 2010 rating decision, a claim of entitlement to service connection for a heart disorder was denied. At the time of that denial, no element of the claim was substantiated. The Veteran did not appeal the May 2010 decision nor was new and material evidence received within the appeal period. In February 2013, the Veteran submitted an application to reopen the claim of entitlement to service connection for a heart disorder. In July 2013, the Veteran filed a claim of entitlement to service connection for sleep apnea. In a November 2013 rating decision, reopening of the heart disorder claim was denied and service connection for sleep apnea was denied. Although notified of the RO’s decision and of her right to appeal, the Veteran did not initiate an appeal of the November 2013 decision (see 38 C.F.R. § 20.200 (2018)). The November 2013 rating decision is the last disallowance on any basis with respect to both claims. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996), overruled on another basis by Hodge v. West 155 F.3d. 1356 (Fed. Cir. 1998) (the Board must review all evidence submitted by or on behalf of a claimant since the last disallowance on any basis to determine whether a claim must be reopened). VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). New evidence is defined as evidence not previously submitted to agency decision makers and material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim(s) sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Where new and material evidence is received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). At any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim. 38 C.F.R. § 3.156(c). To reopen a claim, it is not required that new and material evidence be received as to each previously unproven element of a claim. Where a prior denial was based on lack of current disability and nexus, newly submitted evidence of a current disability was, in concert with evidence already of record establishing an injury in service, new and material and sufficient to reopen the claim and obtain an examination. See Shade v. Shinseki, 24 Vet. App. 100 (2010). For purposes of the “new and material” analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). At the time of the November 2013 decision, the evidence established a current heart disorder. A July 8, 2013, VA outpatient treatment record established a history of mitral valve prolapse 3 or 4 years prior. The evidence did not substantiate any other element necessary for service connection for a heart disorder. At the time of the November 2013 rating decision, the evidence established current sleep apnea. A July 17, 2013, VA outpatient note revealed a history of sleep apnea and that the Veteran was using CPAP. The evidence did not substantiate any other element necessary for service connection for sleep apnea. Evidence received since the November 2013 decision includes VA treatment records, private treatment records, and additional statements from the Veteran and her representative. The medical records are not new and material for purposes of reopening either claim, as they do not address the question of whether post-service diagnosis of mitral valve prolaps and/or sleep apnea are related to service. The Veteran’s statements are also not new and material as she essentially has reiterated her assertion that the noted conditions are related to service. Under these circumstances, the Board must conclude that new and material evidence to reopen the claims for service connection for a heart disorder and sleep apnea has not been received. As such, the November 2013 decision remains final, and the appeal must be denied. As the Veteran has not fulfilled the threshold burden of submitting new and material evidence to reopen either of the finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). Entitlement to service connection for hypertension. For VA rating purposes, hypertension means that diastolic blood pressure is predominately 90 mm. or greater; isolated systolic hypertension means that the systolic blood pressure is predominately 160 mm. or greater with a diastolic blood pressure of less than 90 mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (2018). Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of the presumptive provisions, in order for hypertension to have become manifest to a degree of 10 percent, there must be evidence to substantiate that diastolic pressure is predominantly 100 or more; or, that systolic pressure is 160 or more; or, that there is a history of diastolic pressure predominantly 100 or more and that continuous medication for control is required. See 38 C.F.R. § 4.104, Diagnostic Code 7101. Service treatment records reveal that, on August 16, 2006, an examiner noted that a systolic reading of 139 was not indicative of the Veteran’s true systolic readings based on review of the record (Record 01/24/2007 at 37). A July 28, 2006, Emergency Department Note reveals the Veteran experienced an episode of syncope during physical training. At admission, the following blood pressure readings were noted: 140/90, 136/90, 134/90 (Record 01/24/2007 at 40). Subsequent readings during her stay were as follows: 104/68, 108/72, 110/68, 111/72 (Record 01/24/2007 at 49). In-service blood pressure readings, including those listed above, are as follows: Date Systolic/ Diastolic Date Systolic/ Diastolic May 04 117/ 75 Jun 06 120/ 84 Jan 06 137/ 75 Jul 06 140/ 90 Jan 06 123/ 85 Jul 06 136/ 90 Feb 06 119/ 80 Jul 06 134/ 90 Feb 06 123/ 74 Jul 06 104/ 68 Apr 06 134/ 84 Jul 06 108/ 72 Apr 06 122/ 78 Jul 06 110/ 68 Apr 06 126/ 82 Jul 06 111/ 72 May 06 120/ 82 Jul 06 133/ 93 May 06 124/ 83 Jul 06 131/ 88 May 06 132/ 84 Aug 06 139/ 82 May 06 132/ 79 Aug 06 125/ 86 Jun 06 136/ 70 Sep 06 128/ 89 Jun 06 118/ 78 Sep 06 118/ 82 A report of medical examination performed on September 20, 2006, at service separation, reveals normal clinical findings for the throat, heart and vascular system. Blood pressure was 118/82 (Record 01/24/2007 at 1). A report of medical history completed by the Veteran on the same day as the examination reveals the Veteran’s account that she had no history of, or current, high or low blood pressure or heart trouble (Record 01/24/2007 at 4). The Veteran was separated from active duty service on January 13, 2007. After a review of all of the evidence, the Board finds that the criteria for entitlement to service connection for hypertension have not been met. Based on the established definition for hypertension under VA law, set out above, the Board finds that the Veteran did not have hypertension in service. While she had several diastolic readings of 90 on admission to the emergency department in July 2006, such readings are not the predominant reading as required under the regulation. While it is unclear when hypertension was first diagnosed, there is no such diagnosis within a year of service separation, nor are there blood pressure readings that would qualify as hypertensive within that period. Indeed, the Veteran reported in July 2013, that her prior medical history was negative for hypertension (Record 11/13/2013 at 52). There is no medical opinion that purports to relate hypertension to service. The Board has considered the Veteran’s lay assertions on this point. Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159(a)(2). The Board finds that relating a current diagnosis of vascular hypertension to temporally remote events in service is not the equivalent of relating a broken bone to a concurrent injury to the same body part (Jandreau, at 1377). Such an opinion requires medical knowledge and is not capable of lay observation. Accordingly, the Veteran’s lay statements are not competent evidence of an etiologic relationship between the claimed hypertension and service. In sum, the Board finds that hypertension is not related to service. In light of this finding, the Board concludes that service connection for the claimed hypertension is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Increased Ratings—Law and Regulations Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Entitlement to a disability rating in excess of 70 percent for the service-connected psychiatric disability. The history of this disability is set out in detail in the effective date discussion below. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a disability rating of 70 percent was assigned, effective April 30, 2015. Pertinent to the claim on appeal, the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings for psychiatric disabilities: A 70 percent rating, may be assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). A 100 percent rating contemplates total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. 4.130, Diagnostic Code 9411. The report of a June 2015 VA Examination reveals a diagnosis of PTSD and the examiner’s opinion that it was productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, but that total social and occupational impairment was not demonstrated. The Veteran was noted to be married to her first and only husband, to whom she had been married for over ten years. She was experiencing significant strain in her marriage due to having come back from deployment “a different woman.” She was irritable and had difficulty being understanding with her husband. She had three children. She at times had to isolate herself rather than interacting with her children due to PTSD symptoms. She was interpersonally isolated and felt people don’t understand. No psychiatric hospitalizations were reported. She did not endorse any suicidal or homicidal ideation, plan, or intent. She had intrusive thoughts. She had nightmares once or twice a week. She experienced dissociation. She experienced distress when she saw planes or buildings that resembled Iraq, or when she experienced smells that resembled Iraq. She avoided crowds by shopping late at night. She was interpersonally detached. She slept only four hours a day. Symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effect work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. She experienced physiological reactivity two or three times a day. She avoided discussing military experiences. She stated she has not been to a restaurant or to a movie theater in “a while.” She used to enjoy reading, but no longer enjoyed that activity. She felt everything was a burden. She was interpersonally detached. She felt other people do not understand her or her experiences. She was irritable, stating she feels “rage” and has to take deep breaths to try to calm down. She has difficulty concentrating. She is easily distracted. She starts tasks and often does not follow through on completing the tasks. For example, she will start cooking something on the stove and forget that she has food cooking. She is hypervigilant, as she sits so she can see her surroundings and plans how she would exit a situation if need be. She calls ahead when getting food from a restaurant, ordering food by phone, picking up the take-out order from the food, and quickly leaving the restaurant. She exhibits exaggerated startle response, which includes a pounding sensation in her chest. Her energy level is low. She feels fatigued. Her motivation level is very low, as everything feels like a burden. Her sexual interest is diminished. She experiences feeling of sadness and dissatisfaction with her life circumstances. Her self-esteem is diminished. She is “always washing clothes” and does laundry in a compulsive manner. She experiences some memory difficulties. She forgets when she has appointments even if she gets reminders. She has to refer back to instructions when attempting to follow instructions (Record 06/22/2015 at 10). A private DBQ dated January 2019 reveals the examiner’s opinion that total occupational and social impairment were not demonstrated. The Veteran reported social anxiety, unprovoked irritability, suspiciousness, easy agitation, social withdrawal and unemployment. Symptoms included depressed mood, anxiety, near continuous panic, chronic sleep impairment, difficulty understanding complex commands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, impaired impulse control, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living (Record 03/19/2019). After a review of all of the evidence, the Board finds that the criteria for a total (100 percent) disability rating for the service-connected psychiatric disability have not been met. While the Board acknowledges that the Veteran experiences significant social and occupational impairment as a result of her service-connected psychiatric disability, the evidence does not establish that such impairment is total. The opinion that she submitted in support of her claim is in agreement with that obtained by VA, that total social and occupational impairment is not demonstrated. On examination, the Veteran has been generally oriented and able to discuss her condition with the examiner. Here speech and behavior have been generally within normal limits. In short, the gross impairment of behavior resulting in severe disorientation of the individual which is contemplated by the 100 percent rating criteria, is simply not evident in this case at any time. The Board finds that the service-connected psychiatric disability has been manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. In light of this finding, the Board concludes that a disability rating in excess of 70 percent for the service-connected psychiatric disability is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 371 (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). Entitlement to a disability rating in excess of 50 percent for the service-connected headaches. The history of this disability is set out in detail in the effective date discussion below. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a rating higher than 50 percent was denied. Under Diagnostic Code 8100, migraine headaches are assigned a rating of 50 percent with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. There is no higher rating for headaches. In the August 2015 decision on appeal, the RO denied the claim due to the Veteran’s failure to report for a scheduled VA examination. In the Notice of Disagreement, the Veteran indicated her willingness to attend a rescheduled examination, along with several other missed examinations. While the RO rescheduled her knee and spine examination, it did not reschedule the headaches examination due to the Veteran’s assigment of the maximum rating for headaches. After a review of all of the evidence, the Board agrees that the Veteran is currently receiving the maximum rating available for the service-connected disability. The Veteran has not identified, and the evidence does not other suggest, any additional symptomatology or impairment that is not contemplated in the maximum rating currently assigned, which specifically considers economic inadaptability of any type, nor has the Veteran suggested another diagnostic code. In sum, the Board finds that the service-connected headaches have been manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. In light of these findings, the Board concludes that a disability rating in excess of 50 percent for the service-connected headaches is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 371. Entitlement to a disability rating in excess of 10 percent for the service-connected tinnitus. The current appeal arises from a claim of entitlement to service connection for tinnitus that was received at VA on April 30, 2015. In the August 2015 rating decision, VA granted service connection for tinnitus and assigned an initial disability rating of 10 percent under Diagnostic Code 6260, effective April 30, 2015. Under Diagnostic Code 6260, recurrent tinnitus is assigned a 10 percent rating, which is the maximum rating available. Moreover, under VA law, 38 C.F.R. § 4.25 and Diagnostic Code 6260, limit a claimant to a single disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus. 38 C.F.R. §4.87, Diagnostic Code 6260. The Veteran has not identified, and the evidence does not other suggest, any additional symptomatology or impairment that is not contemplated in the maximum rating currently assigned. In sum, the Board finds that the service-connected tinnitus has been manifested by a sound perceived in the ears. In light of this finding, the Board concludes that a disability rating in excess of 10 percent for the service-connected tinnitus is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 371. Entitlement to a disability rating in excess of 10 percent for the service-connected right and left knee disabilities. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a rating higher than 10 percent was denied. Under Diagnostic Code 5257, recurrent subluxation or lateral instability of the knee is assigned a rating of 30 percent if severe; a rating of 20 percent if moderate; and a rating of 10 percent if slight. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Lateral is defined as denoting a position farther from the median plan or midline of the body or structure. See Dorland's Illustrated Medical Dictionary 1022 (31st ed. 2007). Under Diagnostic Code 5258, a rating of 20 percent is assigned for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Under Diagnostic Code 5259, a rating of 10 percent is assigned for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Under Diagnostic Code 5260, limited flexion merits a rating of 30 percent where flexion is limited to 15 degrees; 20 percent where flexion is limited to 30 degrees; 10 percent where flexion is limited to 45 degrees; and 0 percent where flexion is limited to 60 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limited extension merits a rating of 50 percent where extension is limited to 45 degrees; 40 percent where extension is limited to 30 degrees; 30 percent where extension is limited to 20 degrees; 20 percent where extension is limited to 15 degrees; 10 percent where extension is limited to 10 degrees; and 0 percent where flexion is limited to5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Board notes that the criteria under Diagnostic Codes 5257, 5260, and 5261 are not considered to be overlapping, and therefore separate ratings can be assigned where appropriate symptomatology is shown. The report of a June 2017 VA Examination reveals a diagnosis of bilateral patellofemoral pain syndrome and degenerative arthritis. she has limited ability to walk or stand without pain and intermittent swelling in the bilateral knees. She reported flares of pain in both knees when getting up from a sitting position, walking or standing for extended periods. She reported “I am not able to walk or stand for long periods, or sit for extended periods of time, when I get up my knees are really painful for a few minutes until I get going.” Right flexion was measured from 0 to 120 degrees; extension was to 0 degrees. Left flexion was from 0 to 130 degrees; extension was to 0 degrees. Pain was noted on flexion of both knees. There was evidence of pain with weight bearing. After 3 repetitions, there was no additional limitation of motion for either knee. Muscle strength was full, with no atrophy. There was no history of, or current, subluxation or lateral instability. Testing of anterior instability, medial instability, and lateral instability, were all normal. There was no history of meniscal involvement (Record 06/17/2017). After a review of all of the evidence, the Board finds that the criteria for a disability rating higher than 10 percent for the service-connected right and/or left knee disability have not been met. The rating schedule specifies the measured range of motion which is necessary to substantiate a higher rating for knee disabilities. In this case, the measured range of motion from 0 degrees of extension to at least 120 degrees of flexion does not substantiate any rating higher than the currently assigned 10 percent. In order to warrant a higher rating on the basis of limitation of flexion, the evidence would have to substantiate that flexion was limited to 30 degrees. In order to substantiate a minimum compensable rating for limitation of extension, the evidence would have to substantiate that extension was limited to 10 degrees. The Board has also considered whether a separate compensable rating is warranted for other knee symptomatology. However, in light of the absence of meniscal pathology and the absence of symptomatology such as lateral instability and subluxation, the Board finds that no additional ratings are warranted. As the June 2017 VA examination included measurements of both knees and included testing with weight-bearing and non-weight-bearing, the examination appears to be compliant with Correia v. McDonald, 28 Vet. App. 158 (2016). In sum, the Board finds that the service-connected bilateral knee disabilities have been manifested by arthritis with painful motion that is not limited to a compensable degree, and without meniscal pathology, recurrent subluxation, or lateral instability. In light of these findings, the Board concludes that a disability rating in excess of 10 percent for either service-connected knee disability is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 371. Entitlement to a disability rating in excess of 10 percent for the service-connected thoracolumbar spine disability. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a rating higher than 10 percent was denied. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. A rating of 100 percent requires unfavorable ankylosis of the entire spine. A rating of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. A rating of 40 percent requires forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A rating of 20 percent requires forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A rating of 10 percent is assigned with forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Formula, Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, General Formula, note (2) (See also Plate V). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Formula, Note (5). The report of a June 2017 VA Examination reveals a diagnosis of lumbosacral strain. The Veteran reported “I have pain flares several times daily when sitting, walking or standing for extended periods of time. “I have difficulty bending, lifting, walking sitting or standing for extended periods of time.” Forward flexion was to 80 degrees; extension was to 30 degrees; Right lateral flexion was measured to 20 degrees; Left lateral flexion was measured to 30 degrees; right rotation was to 20 degrees and left rotation was to 30 degrees. There was evidence of pain with weight bearing. The Veteran was able to perform repetitive testing. Guarding and muscle spasms did not result in abnormal gait or abnormal spinal contour. Muscle strength was full, with no atrophy. Lower extremity sensory examination was normal and there was no radiculopathy, IVDS, or neurological abnormalities. X-rays were normal (Record 06/17/2017). After a review of all of the evidence, the Board finds that the criteria for a disability rating higher than 10 percent for the service-connected thoracolumbar spine disability have not been met. The rating schedule specifies the measured range of motion which is necessary to substantiate a higher rating. In this case, the measured range of motion to 80 degrees of forward flexion and 210 degrees combined range of motion does not substantiate any rating higher than the currently assigned 10 percent. As the June 2017 VA examination included testing with weight-bearing and non-weight-bearing and as there is no opposite undamaged joint, the examination appears to be compliant with Correia, 28 Vet. App. 158 (2016). In sum, the Board finds that the service-connected thoracolumbar spine disability has been manifested by painful motion with thoracolumbar spine flexion to at least 80 degrees and with combined range of motion to at least 210 degrees. In light of this finding, the Board concludes that a disability rating in excess of 10 percent for the service-connected thoracolumbar spine disability is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 371. Effective Dates—Law and Regulations The law regarding effective dates provides that, unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C.A. § 5110(a). The applicable effective date statute and regulations provide that the proper effective date for increased rating claims is the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if a claim is received within one year from such date; otherwise, the effective date is the date of receipt of claim for increased rating. 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). If the increase occurred more than one year prior to the claim, the increase is effective the date of the claim for increase. Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98. The Federal Circuit has reaffirmed that “the plain language of [section] 5110(b)(2)...only permits an earlier effective date for increased disability compensation if that disability increased during the one-year period before the filing of the claim.” Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010). A specific claim in the form prescribed by the Secretary 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.A. § 5101(a); 38 C.F.R. § 3.151(a) (2018). Entitlement to an effective date earlier than April 30, 2015, for the rating of 70 percent for the service-connected psychiatric disability. In an April 2007 rating decision, service connection was granted for a psychiatric disorder, which was assigned a disability rating of 30 percent under Diagnostic Code 9411, effective January 14, 2007. The Veteran did not appeal the April 2007 decision nor was new and material evidence received within the appeal period. A routine review examination was ordered in November 2008. A December 2008 rating decision proposed to decrease the rating to 0 percent due to failure to report for a November 2008 VA examination. The Veteran subsequently reported for the examination in December 2008. An April 2009 rating decision continued the rating at 30 percent. The Veteran did not appeal the April 2009 decision nor was new and material evidence received within the appeal period. The Veteran filed a claim for increase in July 2013. In a November 2013 rating decision, the rating was increased to 50 percent, effective July 15, 2013. The Veteran did not appeal the November 2013 decision nor was new and material evidence received within the appeal period. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a disability rating of 70 percent was assigned, effective April 30, 2015. After a review of all of the evidence, the Board finds that there is no legal basis to assign an earlier effective date for the grant of a 70 percent rating for the service-connected psychiatric disability. The November 2013 rating decision became final after the expiration of the one-year appeal period. The April 30, 2015, claim, which is the claim currently on appeal, was received more than one year after the November 2013 rating decision. Accordingly, the decision is now final. To the extent that the Veteran now seeks to revisit that decision, such claim is without merit and must be dismissed as a freestanding claim for an earlier effective date. See Leonard v. Nicholson, 405 F3d 1333 (Fed Cir 2005); Rudd v. Nicholson, 20 Vet. App. 296 (2006). To hold otherwise would vitiate the rule of finality, which was expounded upon in Cook v. Principi, 318 F.3d 1334 (Fed. Cir. 2002). The only valid basis to attack a final rating decision is by Clear and Unmistakable Error (CUE). The pleading requirements for a CUE claim are specific and precise. The Veteran has made no allegation of CUE in this case. The Board has considered whether the increase in the disability occurred during the one-year prior to the date of claim. However, this is not factually ascertainable from the record. In a September 9, 2014, VA Mental Health Note, the Veteran reported a resurgence of symptoms several months prior, corresponding to running out of medications (Record 08/13/2015 at 53). However, this was described as an exacerbation of symptoms and was directly linked to stopping medications, not an actual worsening of the disability. In a separate report of the same date, the Veteran described her mental health as “fair.” She was found to have good judgment and insight, intact memory, normal thought processes and content, normal perceptions (Record 08/13/2015 at 40). The Board finds that there is no basis in the clinical record to establish an effective during the year prior to the claim. In sum, the Board finds that the earliest date of a pending increased rating claim is April 30, 2015. In light of this finding, the Board concludes that an effective date earlier than April 30, 2015, for the assignment of a rating of 70 percent for the service-connected psychiatric disability is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Entitlement to an effective date earlier than April 30, 2015, for the rating of 50 percent for headaches. In an April 2007 rating decision, service connection was granted for headaches, which was assigned a disability rating of 0 percent under Diagnostic Code 8100, effective January 14, 2007. The Veteran did not appeal the April 2007 decision nor was new and material evidence received within the appeal period. On January 26, 2010, the Veteran filed an informal claim for increase. In a May 2010 rating decision, the rating was increased to 30 percent, effective January 26, 2010. The Veteran did not appeal the May 2010 decision nor was new and material evidence received within the appeal period. The Veteran filed a claim for increase in July 2013. In a November 2013 rating decision, the rating was increased to 50 percent, effective July 15, 2013. The Veteran did not appeal the November 2013 decision nor was new and material evidence received within the appeal period. The current appeal arises from an increased rating claim received at VA on April 30, 2015. In the August 2015 rating decision, a rating higher than 50 percent was denied. After a review of all of the evidence, the Board finds that there is no legal basis to assign an earlier effective date for the grant of a 50 percent rating for the service-connected headaches. The November 2013 rating decision became final after the expiration of the one-year appeal period. The April 30, 2015, claim, which is the claim currently on appeal, was received more than one year after the November 2013 rating decision. Accordingly, the decision is now final. To the extent that the Veteran now seeks to revisit that decision, such claim is without merit and must be dismissed as a freestanding claim for an earlier effective date. Leonard, 405 F3d 1333; Rudd, 20 Vet. App. 296. The only valid basis to attack a final rating decision is by CUE. The Veteran has made no allegation of CUE in this case. The Board has considered whether the increase in the disability occurred during the one-year prior to the date of claim. However, this is not factually ascertainable from the record. A September 9, 2014, VA Primary Care Note reveals a frequent headache 2-3 times per week (Record 08/13/2015 at 34). However, as early as July 8, 2013, the Veteran was reporting “frequent” headaches which were associated with nausea and sensitivity to light and noise (Record 08/13/2015 at 42). On July 13, 2013, she described her headaches as “very severe” (Record 08/13/2015 at 22). The Board finds that there is no basis in the clinical record to establish an effective during the year prior to the claim. In sum, the Board finds that the earliest date of a pending increased rating claim is April 30, 2015. In light of this finding, the Board concludes that an effective date earlier than April 30, 2015, for the assignment of a rating of 50 percent for the service-connected headaches is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Entitlement to an effective date earlier than April 30, 2015, for the rating of 10 percent for tinnitus. The current appeal arises from a claim of entitlement to service connection for tinnitus, which was received at VA on April 30, 2015. In the August 2015 rating decision, VA granted service connection for tinnitus and assigned an initial disability rating of 10 percent under Diagnostic Code 6260, effective April 30, 2015. There is no prior claim regarding tinnitus. After a review of all of the evidence, the Board finds that there is no legal basis to assign an earlier effective date for either the grant of service connection or the assignment of a rating of 10 percent for tinnitus. Here, there is no pending claim of any description regarding tinnitus prior to April 30, 2015. Accordingly, the claim is without merit and must be dismissed as a freestanding claim for an earlier effective date. Leonard, 405 F3d 1333; Rudd, 20 Vet. App. 296. Continued on Next Page In sum, the Board finds that the earliest date of a pending claim is April 30, 2015. In light of this finding, the Board concludes that an effective date earlier than April 30, 2015, for the grant of service connection or assignment of a rating of 10 percent for the service-connected tinnitus is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. K. A. KENNERLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Cramp The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.