Citation Nr: 20028845 Decision Date: 04/24/20 Archive Date: 04/24/20 DOCKET NO. 19-21 311 DATE: April 24, 2020 ORDER New and material evidence having not been received, the Veteran’s claim for entitlement to service connection for alopecia, is not reopened. New and material evidence having been received, the Veteran’s claim for entitlement to service connection for gastroesophageal reflux disease (GERD), is reopened. Entitlement to service connection for an acquired psychiatric disability to include unspecified depressive disorder, anxiety and posttraumatic stress disorder (PTSD), to include as secondary to service-connected obstructive sleep apnea (OSA), lumbar spine, radiculopathy, left knee, and bilateral hip disabilities, is granted. Entitlement to an effective date prior to August 11, 2017, for the grant of service connection for limitation of rotation of the left hip associated with service-connected left hip degenerative joint disease (DJD), is denied. Entitlement to an effective date prior to August 11, 2017, for the grant of service connection for limitation of rotation of the right hip associated with service-connected right hip DJD, is denied. Entitlement to an effective date prior to August 11, 2017, for the grant of service connection for limitation of flexion of the left hip associated with service-connected left hip DJD, is denied. Entitlement to an effective date prior to August 11, 2017, for the grant of service connection for limitation of flexion of the right hip associated with service-connected right hip DJD, is denied. REMANDED Entitlement to service connection for GERD is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected left hip DJD is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected right hip DJD is remanded. Entitlement to an initial compensable rating for service-connected limitation of rotation of the left hip is remanded. Entitlement to an initial compensable rating for service-connected limitation of rotation of the right hip is remanded. Entitlement to an initial compensable rating for service-connected limitation of flexion of the left hip is remanded. Entitlement to an initial compensable rating for service-connected limitation of flexion of the right hip is remanded. Entitlement to a compensable rating for service-connected left great toe onychomycosis is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected dermatitis and urticaria of the right leg (previously rated as dermatitis) is remanded. Entitlement to a rating in excess of 10 percent disabling prior to May 15, 2015, a rating in excess of 20 percent disabling prior to August 8, 2018, and a rating in excess of 20 percent disabling beginning November 1, 2018, for service-connected left knee osteoarthritis status post meniscus tear, is remanded. Entitlement to a rating in excess of 20 percent disabling prior to January 29, 2018, in excess of 40 percent disabling prior to February 9, 2018, and in excess of 40 percent disabling beginning May 1, 2018, for service-connected intervertebral disc syndrome (IVDS) lumbar spine is remanded. FINDINGS OF FACT 1. In a final decision issued in September 2013, the RO denied the claim for service connection for alopecia. 2. Evidence added to the record since the final September 2013 denial is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for alopecia. 3. In a final decision issued in September 2013, the RO denied the claim for service connection for GERD. 4. Evidence added to the record since the final September 2013 denial is not cumulative or redundant of the evidence of record at the time of the prior decision and does raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for GERD. 5. Resolving all doubt in the Veteran’s favor, his currently diagnosed acquired psychiatric disability was caused by or is related to his service connected OSA, lumbar spine, radiculopathy, left knee, and bilateral hip disabilities. 6. In August 2017 the Veteran filed a claim for an increased rating for his service-connected bilateral hip disabilities. 7. In August 2017, the Veteran underwent a VA Hip and Thigh Conditions examination, which revealed limitation of rotation and flexion of the Veteran’s bilateral hips; in a September 2017 rating decision the RO granted the Veteran service connection for limitation of rotation and flexion of the bilateral hips with noncompensable evaluations effective August 11, 2017, the date his claim was received. 8. The Veteran did not file a claim of entitlement to service connection for limitation of rotation and flexion of the bilateral hips or a claim for increase for his service-connected bilateral hip disabilities, or a claim that can be reasonably construed as a claim for such, prior to August 11, 2017. CONCLUSIONS OF LAW 1. The September 2013 rating decision that denied the Veteran’s claim of entitlement to service connection for alopecia is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. New and material evidence has not been received to reopen the claim of entitlement to service connection for alopecia. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. The September 2013 rating decision that denied the Veteran’s claim of entitlement to service connection for GERD is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 4. New and material evidence has been received to reopen the claim of entitlement to service connection for GERD. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 5. The criteria for service connection for an acquired psychiatric disability, as secondary to service-connected OSA, lumbar spine, radiculopathy, left knee, and bilateral hip disabilities, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 6. The criteria for an effective date prior to August 11, 2017, for service-connected limitation of rotation of the left hip associated with service-connected left hip DJD have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 7. The criteria for an effective date prior to August 11, 2017, for service-connected limitation of rotation of the right hip associated with service-connected right hip DJD have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 8. The criteria for an effective date prior to August 11, 2017, for service-connected limitation of flexion of the left hip associated with service-connected left hip DJD have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 9. The criteria for an effective date prior to August 11, 2017, for service-connected limitation of flexion of the right hip associated with service-connected right hip DJD have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1992 to August 2013. The Board must discuss all theories of entitlement raised by the Veteran or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545 (2008). Accordingly, the Board has recharacterized the claims as indicated above to afford the Veteran the broadest possible scope of review. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). The Board notes that the Veteran appealed a June 2018 rating decision which denied the Veteran’s claims of entitlement to service connection for a dental condition and a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. Furthermore, a statement of the case was issued in September 2019 and the Veteran filed a substantive appeal (via VA Form 9) in September 2019. However, such claims have not been certified to the Board and are therefore not on appeal at this time. Furthermore, in April 2020 the RO issued a rating decision in which they granted the Veteran a TDIU and Dependent’s Educational Assistance (DEA), both effective January 27, 2020. In addition, the RO continued the Veteran’s ratings for his service-connected left knee osteoarthritis, IVDS and OSA. The Board notes that as the Veteran already had claims pending for increased ratings for his service-connected left knee osteoarthritis and IVDS, such claims are before the Board at this time, however as the Veteran has not expressed disagreement with the effective date assigned for his TDIU or DEA benefits or the continuance of the rating for his service-connected OSA, such are not before the Board at this time. Petitions to Reopen and Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time, he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran’s filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292 (1991). Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104 (a). The claimant has one year from notification of a RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105 (b) and (c); 38 C.F.R. §§ 3.160 (d), 20.200, 20.201, 20.202, and 20.302(a). Generally, a claim which has been denied in an unappealed Board decision or an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104 (b), 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing 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 prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The Court has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). New and material evidence having not been received, the Veteran’s claim for entitlement to service connection for alopecia, is not reopened. The Veteran initially claimed entitlement to service connection for alopecia in March 2013, which was denied in a decision issued in September 2013. At the time of the September 2013 decision, the RO considered the Veteran’s service treatment records as well as post-service treatment records and an April 2013 examination. The RO found that the record did not show that the Veteran had a clinical diagnosis for alopecia or that such condition had occurred in or was caused by service. In this regard, the Veteran’s service treatment records are negative for complaints, treatment, or diagnoses referable to alopecia. Furthermore, the Veteran’s post-service treatment records are also silent for any treatment or diagnosis of such and there was no evidence linking such to the Veteran’s service or other service-connected disabilities. The Veteran was advised of the decision and his appellate rights. However, no further communication regarding his claim of entitlement to service connection for alopecia was received until August 2017, when VA received his application to reopen such claim. Therefore, the September 2013 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156 (b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no evidence pertaining to the Veteran’s claim for service connection for alopecia was received prior to the expiration of the appeal period stemming from the September 2013 rating decision. See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999). The evidence received since the September 2013 rating decision includes additional treatment records, VA examinations, private examinations and opinions as well as lay statements. However, while such records document treatment for a variety of conditions, they do not reflect any findings which diagnose alopecia or that relate such a condition to the Veteran’s active duty service. Additionally, while the Veteran has submitted statements regarding the onset and continuity of alopecia during the course of the appeal, such are duplicative of his contentions that were previously of record at the time of the September 2013 rating decision. Specifically, he simply continues to contend that his condition is the result of or began during service. Therefore, the Board finds that the evidence received since the September 2013 rating decision is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for alopecia. Consequently, new and material evidence has not been received to reopen such claim and the Veteran’s appeal must be denied. New and material evidence having been received, the Veteran’s claim for entitlement to service connection for GERD, is reopened. The Veteran initially claimed entitlement to service connection for GERD in March 2013, which was denied in a decision issued in September 2013. At the time of the September 2013 decision, the RO considered the Veteran’s service treatment records as well as post-service treatment records and an April 2013 examination. The RO found that the record did not show that the Veteran had a clinical diagnosis for GERD or that such condition had occurred in or was caused by service. In this regard, the Veteran’s service treatment records are negative for complaints, treatment, or diagnoses referable to GERD. Furthermore, the Veteran’s post-service treatment records were also silent for any treatment or diagnosis of such and there was no evidence linking such to the Veteran’s service or other service-connected disabilities. The Veteran was advised of the decision and his appellate rights. However, no further communication regarding his claim of entitlement to service connection for GERD was received until August 2017, when VA received his application to reopen such claim. Therefore, the September 2013 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156 (b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no evidence pertaining to the Veteran’s claim for service connection for alopecia was received prior to the expiration of the appeal period stemming from the September 2013 rating decision. See also Bond, 659 F.3d at 1367; Roebuck, 20 Vet. App. at 316; Muehl, 13 Vet. App. at 161-62. The evidence received since the September 2013 rating decision includes additional treatment records, VA examinations, private examinations and opinions as well as lay statements. Furthermore, the VA examinations include an Esophageal examination conducted sometime in 2013 which indicated that the Veteran began to have problems with GERD while deployed in 2009. In addition, the Veteran contends that his GERD began during his active duty service and has continued since. The Board notes that the Veteran is capable of reporting observable symptoms of an injury or illness, as well as the length of time those symptoms have persisted. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Presuming the credibility of the Veteran’s statements pursuant to Justus, 3 Vet. App. at 513 and, in light of the 2013 VA Esophageal Conditions examination, which not only confirmed a diagnosis of GERD, but seems to indicate that such began during the Veteran’s active service, the Board finds that the evidence received since the September 2013 rating decision is neither cumulative nor redundant, and raises the possibility of substantiating the claim of service connection. See 38 C.F.R. § 3.156 (a). In this regard, the Veteran’s claim for service connection for GERD was previously denied in September 2013 as the record did not indicate that the claimed condition had been formally diagnosed or that such was related to the Veteran’s active duty service. Since such time, the Veteran’s records indicate that the Veteran not only has a diagnosis of GERD, but that such began during his active duty service. Therefore, based on the foregoing reasons, the Board finds that new and material evidence has been received and, accordingly, the claim of entitlement to service connection for GERD is reopened, and the appeal is granted, to this extent only. Entitlement to service connection for an acquired psychiatric disability to include unspecified depressive disorder, anxiety and PTSD, to include as secondary to service-connected OSA, lumbar spine, radiculopathy, left knee, and bilateral hip disabilities, is granted. The Veteran alleges that he suffers from an acquired psychiatric disability, to include unspecified depressive disorder, anxiety and/or PTSD, as a result of his active duty service. Specifically, the Veteran contends that his acquired psychiatric disability was caused or aggravated by his service-connected OSA, lumbar spine and radiculopathy, left knee, and bilateral hip disabilities. The Veteran’s service treatment records are silent for any complaints, treatment, or diagnosis of an acquired psychiatric disability. However, post-service the Veteran’s treatment records reflect psychiatric complaints as well as treatment for anxiety and a diagnoses of unspecified anxiety disorder and unspecified depressive disorder. In December 2014, the Veteran underwent a VA Mental Health examination with an accompanying disability benefits questionnaire (DBQ). The examiner found that the Veteran did not meet the diagnostic criteria for PTSD, but that the Veteran did meet the diagnostic criteria for unspecified anxiety disorder. However, the examiner found that there was no link between the Veteran’s mental health disability and his active duty service. In May 2015, the Veteran again underwent another VA Mental Health examination with an accompanying DBQ. The examiner again found that the Veteran did not meet the diagnostic criteria for PTSD. However, the examiner found that the Veteran did meet the diagnostic criteria for unspecified depressive disorder. The examiner provided the opinion that there is no evidence to support that the Veteran’s current symptoms associated with his unspecified depressive disorder were caused by or related to his service or any in-service illness, injury or event. The examiner noted that the Veteran’s service treatment records were silent for any psychiatric complaints and the Veteran reported no psychiatric complaints for many years following his discharge from service. However, the examiner did note that the Veteran reported some depressive symptoms in his early 20s prior to his enlistment. In November 2019, the Veteran underwent a private Mental Health examination with an accompanying DBQ. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD, but that he did have unspecified depressive disorder. The examiner found that while the Veteran experienced trauma in service, he did not relive such trauma. The examiner opined that it is as likely as not that the Veteran’s anxiety disorder is caused by his service-connected conditions including OSA, lumbar spine and radiculopathy, left knee, and bilateral hips. Throughout the appeal, the Veteran has submitted statements in support of his claim. The Veteran has continuously alleged that he suffers from an acquired psychiatric disability as a result of his service or his service-connected disabilities. The Board notes that whether the Veteran has a current acquired psychiatric disability is also not in dispute. While the Veteran contends that he suffers from PTSD, both VA and private examiners have determined that the Veteran does not meet the diagnostic criteria for such. However, the Veteran’s post-service treatment records reflect his complaints of psychiatric symptoms and all the examinations of record, to include December 2014, May 2015, and November 2019 reflects diagnoses of unspecified anxiety disorder and unspecified depressive disorder. Therefore the first element of service connection either presumptive, direct or secondary is met. As far as presumptive service connection, the Board notes that the Veteran’s service treatment records are silent for any complaints or treatment for an acquired psychiatric disability and there is no evidence that such was diagnosed during service. Therefore, service connection for such disability on the basis that it became manifest in service and has persisted is not warranted. Moreover, there is no evidence of an acquired psychiatric disability being manifest in the first post-service year. Finally, such are not chronic diseases listed under 38 U.S.C. §§ 1112,1137; 38 C.F.R. §§ 3.307, 3.309. Therefore, presumptive service connection is not warranted. As far as direct service connection, the Board notes that the medical evidence is not in dispute as to whether the Veteran had an acquired psychiatric disability in-service or whether such began in service. Furthermore, the Veteran has not alleged that his psychiatric disability is directly related to service. Rather, he has alleged that such is secondary to his OSA, lumbar spine, radiculopathy, left knee, and bilateral hip disabilities. Therefore, as the Veteran is missing essential elements of direct service connection, the in-service element and the nexus element (as both VA examiners of record provided opinions that found that the Veteran’s acquired psychiatric disabilities were not the result of and did not begin in service), the Board finds that direct service connection is not warranted. As far as secondary service connection, the Board notes that the Veteran is service-connected for OSA, lumbar spine and radiculopathy, left knee, and bilateral hip disabilities, therefore, while direct service connection is not warranted, secondary service connection is available to the Veteran. The question which remains is whether the Veteran’s current acquired psychiatric disability is causally related to his service-connected disabilities. The Board notes that the private examiner provided the opinion that it was at least as likely as not that the Veteran’s service-connected OSA, lumbar spine, radiculopathy, left knee, and bilateral hip disabilities aided in the development of and/or permanently aggravated the Veteran’s acquired psychiatric disability. Under the circumstances, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s acquired psychiatric disability was caused or permanently aggravated by his service-connected disabilities. Resolving all remaining reasonable doubt in the Veteran’s favor, the Board finds that service connection for an acquired psychiatric disability, as secondary to his service-connected disabilities is warranted, and the appeal in this matter must be granted. Earlier Effective Date Except as otherwise provided, the effective date of an award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later (emphasis added). 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 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. § 5101 (a); 38 C.F.R. § 3.151 (a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). However, any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, from a Veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the Veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155. Entitlement to an effective date prior to August 11, 2017, for the grants of service connection for limitation of rotation and flexion of the bilateral hips associated with service-connected bilateral hip DJD, is denied. The Veteran generally contends that an effective date prior to August 11, 2017, is warranted for the award of service connection for limitation of rotation and flexion of the bilateral hips associated with service-connected bilateral hip DJD. However, no further argument was submitted in support of his contentions. As previously noted, the effective date for a grant of service connection is the day after separation from service or day entitlement arose, if a claim is received within one year of separation from service, otherwise the date of receipt of claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110 (b)(1); 38 C.F.R.§ 3.400 (b)(2)(i). A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1 (p), 3.151, 3.155; Rodriguez v. West, 189 F.3d 1351 (Fed.Cir. 1999); Lalonde v. West, 12 Vet. App. 377 (1999). Treatment records do not constitute informal claims when service connection has not yet been established for the condition. 38 C.F.R. § 3.157; Sears v. Principi, 16 Vet. App. 244 (2002). While the VA should broadly interpret submissions from a Veteran, it is not required to conjure up claims not specifically raised. Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). In regard to the Veteran’s bilateral hip claims, a review of the record reveals the first claim, formal or informal, seeking an increased rating which lead to service connection for such disabilities was the Veteran’s August 2017 claim received by the RO on August 11, 2017. The Board notes that it was not within one year of the Veteran’s discharge from service, which was August 2013. By rating action dated in September 2017, the RO granted service connection for limitation of rotation and flexion of the Veteran’s bilateral hips associated with bilateral hip DJD. The claim for service connection was granted as the RO found that the Veteran’s bilateral hip DJD had resulted in bilateral limitation of rotation and flexion. In awarding service connection, the RO assigned an effective date based on the date of receipt of the initial claim for an increased rating for his service-connected bilateral hip DJD, i.e., August 11, 2017. While the Veteran may have experienced bilateral hip symptomatology prior to August 11, 2017, the effective date of an award of service connection is assigned not based on the date the Veteran claims the disability appeared or the date of the earliest medical evidence demonstrating the existence of such disability and a causal connection to service; rather, the effective date is assigned based on consideration of the date that the application upon which service connection was eventually awarded was received by VA. See LaLonde v. West, 12 Vet. App. 377, 382-383 (1999). Therefore, for the foregoing reasons, the Board finds there is no legal basis upon which to assign an effective date prior to August 11, 2017, for the grant of service connection for limitation of rotation and flexion of the bilateral hips associated with bilateral hip DJD. Accordingly, the preponderance of the evidence is against the Veteran’s earlier effective date claims. As such, the benefit-of-the-doubt doctrine does not apply, and the Veteran’s claims must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. REASONS FOR REMAND Although the Board regrets the delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s remaining claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Entitlement to service connection for GERD is remanded. The Veteran alleges that he suffers from GERD as a result of his active duty service. Specifically, the Veteran contends that his GERD began during his deployment in 2009 and has continued ever since. VA’s duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); Duenas v. Principi, 18 Vet. App. 512 (2004); Robinette v. Brown, 8 Vet. App. 69 (1995); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). For below noted reasons, the Board finds that an additional VA examination is needed in order to determine the nature and etiology of the Veteran’s claimed GERD. The Veteran’s service treatment records are silent for any complaints, treatment or definitive diagnosis of GERD. However, a notation while the Veteran was receiving dental care indicates that the Veteran may have GERD. Post-service the Veteran was diagnosed with GERD. In 2013, the Veteran underwent a VA Esophageal Conditions examination with an accompanying DBQ. The examiner confirmed the Veteran’s GERD diagnosis. Furthermore, the examiner noted that the Veteran reported that his GERD began while he was on deployment in 2009 and that such had continued ever since. However, the examiner did not provide an etiological opinion. Therefore on remand, an additional examination with an etiological opinion should be obtained. Entitlement to ratings in excess of 10 percent disabling for service-connected bilateral hip DJD, to initial compensable ratings for service-connected limitation of rotation and flexion of the bilateral hips, to a compensable rating for service-connected left great toe onychomycosis, to a rating in excess of 10 percent disabling for service-connected dermatitis and urticaria of the right leg, to a rating in excess of 10 percent disabling prior to May 15, 2015, in excess of 20 percent disabling prior to August 8, 2018, and in excess of 20 percent disabling beginning November 1, 2018, for service-connected left knee osteoarthritis status post meniscus tear, and to a rating in excess of 20 percent disabling prior to January 29, 2018, in excess of 40 percent disabling prior to February 9, 2018, and in excess of 40 percent disabling beginning May 1, 2018, for service-connected IVDS lumbar spine, are remanded. Relevant to the Veteran’s claims for increased and compensable ratings for his service-connected bilateral hip, left knee, skin, and lumbar spine disabilities, the Court has held that, where the record does not adequately reveal the current state of a claimant’s disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the last examination. Allday v. Brown, 7 Vet. App. 517, 526 (1995). The Board finds that the Veteran’s claims for increased and compensable ratings for his service-connected bilateral hip, left knee, skin, and lumbar spine disabilities must be remanded in order to afford him contemporaneous adequate VA examinations in order to assess the current nature and severity of his service-connected disabilities. In this regard, the record reflects that the Veteran underwent VA Back and Knee Condition examinations in February 2020. While such are contemporaneous, for below noted reasons, the Board finds them inadequate for adjudication purposes. Furthermore, the record reflects that the Veteran was most recently afforded VA Skin and Hip Condition examinations in August 2017. Since that time, the Veteran has noted an increase in the severity of his symptoms and alleges that higher ratings are warranted. In light of the allegations of worsening symptoms and the amount of time which has passed since the Veteran’s prior examinations, the Board finds that a remand is required in order to afford the Veteran adequate contemporaneous VA examinations so as to determine his current level of impairment with regard to his service-connected bilateral hip, left knee, skin, and lumbar spine disabilities. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). In regard to the Veteran’s examinations for his bilateral hip, left knee, and lumbar spine disabilities, the Board finds, that the additional examinations are also necessary in order to be compliant with the Court’s ruling in Correia v. McDonald, 28 Vet. App. 158 (2016). While the August 2017 and February 2020 VA examiners did answer questions as to pain with weightbearing, passive range of motion, and active range of motion, the examiners did not address whether pain was present on nonweight bearing. Furthermore, they did not provide adequate explanations or rationale for the answers provided and they did not provide any specific values for passive range of motion testing. Therefore, on remand new examinations should include Correia compliant testing along with thorough explanations of the examiner’s findings. The new examinations should include specific findings regarding the Veteran’s range of motion in active motion, passive motion, weightbearing, and non-weightbearing. Additionally, the Board notes that the Court has also held that VA examiners must offer flare and functional impairment opinions based on estimates derived from information procured from relevant sources, including a Veteran’s lay statements. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Furthermore, the Court explained that case law and VA guidelines do not require direct observation of functional impairment after repetitive use or during a flare-up as a prerequisite to offering a DeLuca opinion. DeLuca v. Brown, 8 Vet. App. 202 (1995). Indeed, it is not expected that such observation will usually occur; therefore, VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of veterans. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. Furthermore, in Sharp, the Court noted that for a joint examination to be adequate, the examiner “must express an opinion on whether pain could significantly limit” a veteran’s functional ability, and that determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Furthermore, the Court stated that the examiner must “obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment [resulting from flare-ups] from the veterans themselves.” Sharp, 29 Vet. App. at 34. The examiner must also “offer flare opinions based on estimates derived from information procured from relevant sources, including the lay statements of veterans,” and the examiner’s determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Id. at 10. In this case, the Veteran has alleged that he experiences flares of his bilateral hips, left knee and lumbar spine disabilities, and that he has functional impairment from such conditions. However, while the VA examiners acknowledged that the Veteran had functional impairment in general, they failed to ascertain adequate information, such as the frequency, duration, characteristics or severity of the flares and functional impairment by alternative means and therefore the detailed findings contemplated by the Sharp case have not been included. Therefore, a remand for new VA examinations to adequately address the Correia and Sharp standards is required. 38 C.F.R. § 4.2. Due to the amount of time which will pass on remand, updated treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated treatment records. 2. The Veteran should be provided with a VA examination to determine the nature and etiology of his claimed GERD. The claims file should be made available to the examiner. The examiner should respond to the following: Identify all manifestations of the Veteran’s GERD. Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran’s GERD is related to his service, and/or did the Veteran’s GERD begin during or manifest during his deployment in 2009? The rationale for any opinion offered should be provided. 3. The Veteran should also be afforded a VA examination to determine the current nature and severity of his service-connected bilateral hip disabilities. All indicated testing should be accomplished and all symptomatology associated with such disabilities should be identified. In addition to all findings identified on the appropriate examination form, the examiner should determine the effective range of motion in the Veteran’s bilateral hips and present the results of range of motion tests in a written report which complies with 38 C.F.R. § 4.59 by recording separate sets of the range of motion test results for both active and passive motion, and in weightbearing and non-weightbearing. The examiner’s reports should describe objective evidence of painful motion, if any, during each test. IT IS NOT SUFFICIENT MERELY TO INDICATE WHETHER OR NOT PAIN WAS PRESENT DURING ONE OF THE REQUIRED RANGE OF MOTION TESTS. If any of these findings are not possible, please provide an explanation. In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees. If there is no pain and/or no limitation of function, such facts must be noted in the report. The examiner should comment as to whether there is any medical reason to accept or reject the Veteran’s description of reduced range of motion during flares or repetitive use. The examiner should provide a full description of the effects, to include all associated limitations, of the Veteran’s bilateral hip disabilities on his daily activities and employability. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements. The rationale for any opinion offered should be provided. 4. The Veteran should also be afforded a VA examination to determine the current nature and severity of his service-connected left knee disability. All indicated testing should be accomplished and all symptomatology associated with such disability should be identified. In addition to all findings identified on the appropriate examination form, the examiner should determine the effective range of motion in the Veteran’s left knee and present the results of range of motion tests in a written report which complies with 38 C.F.R. § 4.59 by recording separate sets of the range of motion test results for both active and passive motion, and in weightbearing and non-weightbearing. The examiner’s report should describe objective evidence of painful motion, if any, during each test. IT IS NOT SUFFICIENT MERELY TO INDICATE WHETHER OR NOT PAIN WAS PRESENT DURING ONE OF THE REQUIRED RANGE OF MOTION TESTS. If any of these findings are not possible, please provide an explanation. In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees. If there is no pain and/or no limitation of function, such facts must be noted in the report. The examiner should comment as to whether there is any medical reason to accept or reject the Veteran’s description of reduced range of motion during flares or repetitive use. The examiner should provide a full description of the effects, to include all associated limitations, of the Veteran’s left knee disability on his daily activities and employability. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements. The rationale for any opinion offered should be provided. 5. The Veteran should also be afforded a VA examination to determine the current nature and severity of his service-connected lumbar spine disability. All indicated testing should be accomplished and all symptomatology associated with such disabilities should be identified. In addition to all findings identified on the appropriate examination form, the examiner should determine the effective range of motion in the Veteran’s lumbar spine and present the results of range of motion tests in a written report which complies with 38 C.F.R. § 4.59 by recording separate sets of the range of motion test results for both active and passive motion, and in weightbearing and non-weightbearing. The examiner’s report should describe objective evidence of painful motion, if any, during each test. IT IS NOT SUFFICIENT MERELY TO INDICATE WHETHER OR NOT PAIN WAS PRESENT DURING ONE OF THE REQUIRED RANGE OF MOTION TESTS. If any of these findings are not possible, please provide an explanation. In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees. If there is no pain and/or no limitation of function, such facts must be noted in the report. The examiner should comment as to whether there is any medical reason to accept or reject the Veteran’s description of reduced range of motion during flares or repetitive use. The examiner should provide a full description of the effects, to include all associated limitations, of the Veteran’s lumbar spine disability on his daily activities and employability. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements. The rationale for any opinion offered should be provided. 6. The Veteran should also be afforded a VA examination to determine the current nature and severity of his service-connected skin disabilities, to include left great toe onychomycosis and dermatitis and urticaria of the right leg. All indicated testing should be accomplished and all symptomatology associated with such disabilities should be identified. The examiner should provide a full description of the effects, to include all associated limitations, of the Veteran’s skin disabilities on his daily activities and employability. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements. The rationale for any opinion offered should be provided. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Unger, Counsel 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.