Citation Nr: 20042467 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 18-51 533 DATE: June 24, 2020 ORDER The application to reopen a claim of service connection for a cervical spine condition is denied. The application to reopen a claim of service connection for internal hemorrhoids is granted. The application to reopen a claim of service connection for a left shoulder/arm condition is denied. The application to reopen a claim of service connection for a right shoulder joint condition is denied. The application to reopen a claim of service connection for testosterone imbalance is denied. The application to reopen a claim of service connection for a left wrist condition is denied. The application to reopen a claim of service connection for loss of movement and strength of the left hand is denied. The application to reopen a claim of service connection for a right hip strain is denied. The application to reopen a claim of service connection for a left hip strain is denied. A rating of more than 10 percent since July 17, 2014, for tinnitus is denied. REMANDED The issue of a rating of more than 10 percent for head injury residual scar since July 17, 2014, is remanded. The issue of a compensable rating for bilateral hearing loss since July 17, 2014, is remanded. The issue of an increased rating since July 17, 2014, for lumbar degenerative disc disease (DDD) with spondylosis and spondylolisthesis, currently rated as 10 percent, with right and left lower extremity radiculopathy, currently rated as 10 percent each, is remanded. The issue of service connection for hemorrhoids is remanded. The issue of service connection for, or entitlement to a separate compensable rating for, vision loss is remanded. The issue of service connection for, or entitlement to a separate compensable rating for, insomnia is remanded. The issue of entitlement to a total rating for compensation purposes based on individual unemployability due to service-connected disabilities (TDIU) since July 17, 2014, is remanded. FINDINGS OF FACT 1. In May 2013, the Veteran was notified that VA denied service connection for a cervical spine condition. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit a notice of disagreement (NOD) with the decision. 2. The May 2013 rating decision is final. 3. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a cervical spine condition. 4. In May 2013, the Veteran was notified that VA denied service connection for internal hemorrhoids. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 5. The May 2013 rating decision is final. 6. The additional documentation submitted since the May 2013 rating decision is new and material and raises a reasonable possibility of substantiating the Veteran’s claim of service connection for hemorrhoids. 7. In May 2013, the Veteran was notified that VA denied service connection for a left shoulder/arm condition. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 8. The May 2013 rating decision is final. 9. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a left shoulder/arm condition. 10. In May 2013, the Veteran was notified that VA denied service connection for a right shoulder joint condition. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 11. The May 2013 rating decision is final. 12. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a right shoulder joint condition. 13. In May 2013, the Veteran was notified that VA denied service connection for a testosterone imbalance. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 14. The May 2013 rating decision is final. 15. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for testosterone imbalance. 16. In May 2013, the Veteran was notified that VA denied service connection for a left wrist condition. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 17. The May 2013 rating decision is final. 18. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a left wrist condition. 19. In May 2013, the Veteran was notified that VA denied service connection for loss of movement and strength of the left hand. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 20. The May 2013 rating decision is final. 21. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for loss of movement and strength of the left hand. 22. In May 2013, the Veteran was notified that VA denied reopening a claim of service connection for a right hip strain. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 23. The May 2013 rating decision is final. 24. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a right hip strain. 25. In May 2013, the Veteran was notified that VA denied reopening a claim of service connection for a left hip strain. The Veteran was informed in writing of the adverse determination and his appellate rights and did not submit an NOD with the decision. 26. The May 2013 rating decision is final. 27. The additional documentation submitted since the May 2013 rating decision is not new and material and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for a left hip strain. 28. The Veteran’s tinnitus symptoms do not present an exceptional disability picture such that the schedular rating for tinnitus is inadequate. CONCLUSIONS OF LAW 1. The May 2013 rating decision denying service connection for a cervical spine condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 2. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a cervical spine condition has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 3. The May 2013 rating decision denying service connection for internal hemorrhoids is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 4. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for hemorrhoids has been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 5. The May 2013 rating decision denying service connection for a left shoulder/arm condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 6. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a left shoulder/arm condition has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 7. The May 2013 rating decision denying service connection for a right shoulder joint condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 8. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a right shoulder joint condition has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 9. The May 2013 rating decision denying service connection for testosterone imbalance is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 10. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for testosterone imbalance has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 11. The May 2013 rating decision denying service connection for a left wrist condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 12. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a left wrist condition has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 13. The May 2013 rating decision denying service connection for loss of movement and strength of the left hand is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 14. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for loss of movement and strength of the left hand has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 15. The May 2013 rating decision denying reopening of a claim for service connection for a right hip strain is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 16. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a right hip strain has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 17. The May 2013 rating decision denying reopening of a claim for service connection for a left hip strain is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2019). 18. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a left hip strain has not been presented. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326(a) (2019). 19. The criteria for a rating of more than 10 percent, since July 17, 2014, for tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.87, Diagnostic Code 6260 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from August 2004 to January 2010. He served in Southwest Asia and his military decorations include the Combat Action Badge. The issues of an increased rating for chronic gastritis/esophagitis with a history of peptic ulcer, status-post surgical repair; service connection for hypertension; and service connection for contact dermatitis are currently in remand status before the RO and will be addressed in a separate decision if certified to the Board. New and Material Evidence Generally, absent the filing of an NOD within one year of the date of mailing of the notification of the initial review and determination of a veteran’s claim and the subsequent filing of a timely substantive appeal, a rating determination is final and is not subject to revision upon the same factual basis except upon a finding of clear and unmistakable error (CUE). 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 20.200, 20.300, 20.1103. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. 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 provisions of 38 C.F.R. § 3.156(a) create a low threshold, with the phrase “raises a reasonable possibility of substantiating the claim” enabling rather than precluding reopening and not constituting a third requirement that must be met before the claim is reopened. Shade v. Shinseki, 24 Vet. App. 110 (2010); Evans v. Brown, 9 Vet. App. 273, 283 (1996). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). New and material evidence received prior to the expiration of the appeal period 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). Where documents are within VA’s control and could reasonably be expected to be a part of the record, such documents are, in contemplation of law, before VA and should be included in the record. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). The Board is required to consider the question of whether new and material evidence has been received to reopen the Veteran’s claim without regard to the RO’s determination in order to establish the Board’s jurisdiction to address the underlying claims and to adjudicate the claims on a de novo basis. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). 1. Whether new and material evidence has been received to reopen a claim of service connection for a cervical spine condition. In May 2013, VA denied service connection for a cervical spine condition because the Veteran failed to report for an examination and the record did not indicate that he had a cervical spine disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a cervical spine disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 2. Whether new and material evidence has been received to reopen a claim of service connection for internal hemorrhoids. In May 2013, VA denied service connection for internal hemorrhoids because the evidence did not indicate that he internal or external hemorrhoids. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for hemorrhoids. was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The additional documentation received since the May 2013 rating decision includes a statement from the Veteran that he had chronic hemorrhoids, that his VA treatment records indicate that he had chronic hemorrhoids, and that his hemorrhoids were caused by his service-connected chronic gastritis. When determining whether a claim should be reopened, the credibility of the newly submitted evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). Here, without examination of any other evidence of record, the newly-submitted evidence is of such significance that, when considered for the limited purpose of reopening the Veteran’s claim, it raises a reasonable possibility of substantiating his claim for service connection when considered with the previous evidence of record. As new and material evidence has been received, the Veteran’s claim is reopened. 3. Whether new and material evidence has been received to reopen a claim of service connection for a left shoulder/arm condition. In May 2013, VA denied service connection for a left shoulder/arm condition because the Veteran failed to report for an examination and the record did not indicate that he had a left shoulder or arm disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a left shoulder or arm disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 4. Whether new and material evidence has been received to reopen a claim of service connection for a right shoulder joint condition. In May 2013, VA denied service connection for a right shoulder joint condition because the Veteran failed to report for an examination and the record did not indicate that he had a right shoulder joint disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a right shoulder disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 5. Whether new and material evidence has been received to reopen a claim of service connection for testosterone imbalance. The Veteran did not submit a substantive appeal with the denial of reopening the claim of service connection for testosterone imbalance. The issue was certified to the Board, however, and is, therefore, on appeal. In May 2013, VA denied service connection for testosterone imbalance because the Veteran failed to report for an examination and the record did not indicate that he had a testosterone disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a testosterone disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim and a September 2014 NOD. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 6. Whether new and material evidence has been received to reopen a claim of service connection for a left wrist condition. In May 2013, VA denied service connection for a left wrist condition because the Veteran failed to report for an examination and the record did not indicate that he had a left wrist disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a left wrist disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. The Board notes that relevant VA treatment records were added to the file in November 2019. The relevant records are all dated from 2012, prior to the final May 2013 decision and are presumed to have been considered by the RO in the May 2013 decision. See Bell, 2 Vet. App. at 611. Therefore, they cannot constitute new and material evidence such that the Board can reopen the Veteran’s claim of service connection. No new and material evidence has been received and the claim is not reopened. The appeal is denied. 7. Whether new and material evidence has been received to reopen a claim of service connection for loss of movement and strength of the left hand. In May 2013, VA denied service connection for loss of movement and strength of the left hand because the Veteran failed to report for an examination and the record did not indicate that he had a left-hand disorder which was caused by service or by any service connected disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD. New and material evidence pertaining to the issue of service connection for a left-hand disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 8. Whether new and material evidence has been received to reopen a claim of service connection for a right hip strain. In May 2013, VA denied reopening a claim of service connection for a right hip strain because the Veteran failed to report for an examination and the record did not indicate that he had a right hip disorder which was caused by service or by any service connected disorder. VA had previously denied service connection for a right hip strain in February 2011 because there was no evidence of a current or chronic disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD with the May 2013 rating decision. New and material evidence pertaining to the issue of service connection for a right hip disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 9. Whether new and material evidence has been received to reopen a claim of service connection for a left hip strain. In May 2013, VA denied reopening a claim of service connection for a left hip strain because the Veteran failed to report for an examination and the record did not indicate that he had a left hip disorder which was caused by service or by any service connected disorder. VA had previously denied service connection for a left hip strain in February 2011 because there was no evidence of a current or chronic disorder. The Veteran was informed in writing of the adverse decision and did not submit an NOD with the May 2013 rating decision. New and material evidence pertaining to the issue of service connection for a left hip disorder was not received by VA or constructively in its possession within one year of written notice to the Veteran of the May 2013 rating decision. Therefore, that decision became final. 38 C.F.R. § 3.156(b). The only relevant documents received since the May 2013 rating decision became final are a July 2014 claim, a September 2014 NOD, and a November 2018 VA Form 9. These documents indicated that the Veteran wished to pursue a claim and an appeal for service connection but did not contain any evidence or argument about whether he had a diagnosed disorder that was caused by service or by a service-connected disorder. There was no newly-submitted evidence that could raise a reasonable possibility of substantiating the Veteran’s claim when considered with the previous evidence of record. Therefore no new and material evidence has been received and the claim is not reopened. The appeal is denied. 10. Entitlement to a rating of more than 10 percent since July 17, 2014, for tinnitus. The Veteran did not submit a substantive appeal with the denial of an increased rating for tinnitus. The issue was certified to the Board, however, and is, therefore, on appeal. The Veteran has been in receipt of a 10 percent rating for tinnitus since January 9, 2010. This is the maximum schedular rating available. See 38 C.F.R. § 4.87, Diagnostic Code 6260. In an exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director of the Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability. The governing norm in exceptional cases is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). There is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. Second, if the schedular ratings do not contemplate a Veteran’s level of disability and symptomatology and are found inadequate, the Board must determine whether the Veteran’s disability picture exhibits other related factors such as those provided by the regulation as governing norms. Third, if the rating schedule is inadequate to rate a Veteran’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran’s disability picture requires the assignment of an extra-schedular rating. Thun v. Peake, 22 Vet. App. 111 (2008). On his July 2014 claim for an increased rating, the Veteran only provided information about what he believed the cause was of his tinnitus; he did not provide any information as to his current tinnitus symptoms. He submitted no additional documentation during the pendency of this appeal in which he described his current tinnitus symptoms, indicated that his tinnitus symptoms had worsened, or asserted that he had any tinnitus symptoms not contemplated by the rating schedule. The evidence does not present such an exceptional disability picture that the schedular rating for tinnitus is inadequate. The Veteran reported tinnitus. This symptom is contemplated by diagnostic code 6260. This rating code compensates veterans for tinnitus. The Veteran has made no argument as to why an increased rating beyond the maximum schedular rating of 10 is warranted. Because the Veteran’s symptoms are contemplated by diagnostic code 6260, referral to Under Secretary for Benefits or the Director of the Compensation and Pension Service for consideration of an extraschedular rating is not necessary. The claim for a rating of more than 10 percent for tinnitus is denied. REASONS FOR REMAND 1. The issue of a rating of more than 10 percent for head injury residual scar since July 17, 2014, is remanded. 2. The issue of a compensable rating for bilateral hearing loss since July 17, 2014, is remanded. 3. The issue of an increased rating since July 17, 2014, for lumbar DDD with spondylosis and spondylolisthesis, currently rated as 10 percent, with right and left lower extremity radiculopathy, currently rated as 10 percent each, is remanded. 4. The issue of service connection for hemorrhoids is remanded. 5. The issue of service connection for, or entitlement to a separate compensable rating for, vision loss is remanded. 6. The issue of service connection for, or entitlement to a separate compensable rating for, insomnia is remanded. 7. The issue of entitlement to TDIU since July 17, 2014, is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: Remand of the issues of an increased rating for a head injury residual scar, bilateral hearing loss, and lumbar spine DDD with right and left lower extremity radiculopathy is necessary because the Veteran has not been afforded VA examinations during the period currently on appeal. Remand of the issue of service connection for hemorrhoids is necessary to obtain a new VA examination and medical opinion. A November 2011 VA examination report states that the Veteran did not have evidence of internal or external hemorrhoids. An October 2010 VA examination states a history of hemorrhoids, 2010 and 2012 VA treatment records indicate a diagnosis of hemorrhoids, and an October 2013 VA treatment record states that an April 2013 colonoscopy indicated that he had internal hemorrhoids. Therefore, a new examination and medical opinion is necessary. In May 2020, the RO granted service connection for residuals of a traumatic brain injury (TBI) with posttraumatic stress disorder (PTSD) and service connection for migraine headaches. The issues of service connection for vision loss and insomnia came to the Board as claims to reopen. However, these symptoms have been associated with the Veteran’s TBI, PTSD, and migraine headaches. Therefore, these claims are more appropriately characterized as claims for separate compensable ratings. It is unclear from the May 2020 rating decision whether these symptoms have been accounted for in the ratings assigned for TBI with PTSD and/or migraine headaches. In order to avoid pyramiding, the Board cannot address whether the separate compensable ratings are warranted. Instead, the claims must be remanded so that the ratings for TBI with PTSD and migraine headaches can be reassessed to determine whether vision loss and/or insomnia can be rated as part of those disorders and whether separate compensable ratings are warranted. Entitlement to TDIU is part of the increased rating claims currently before the Board pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The appeal period for each of the increased rating claims begins on July 17, 2014. Therefore, the period for entitlement to TDIU currently before the Board begins on July 17, 2014. This issue is intertwined with the claims being remanded, as well as with the claim currently in remand status before the RO. Therefore, remand is necessary to adjudicate this issue after all directed development has been completed. 2. Schedule the Veteran for a VA scar examination to obtain an opinion as to the current nature of his head injury residual scar. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. 3. Schedule the Veteran for a VA audiological examination to obtain an opinion as to the current nature of his bilateral hearing loss. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. 4. Schedule the Veteran for VA lumbar spine and lower extremity nerve examinations to obtain an opinion as to the current nature of his lumbar spine and lower extremity radiculopathy disorders. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. 5. Schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of his hemorrhoids. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether the Veteran has hemorrhoids. (b.) Whether hemorrhoids were caused by any in service event, injury, disease, or disorder. (c.) Whether hemorrhoids were caused by any service-connected disorder or treatment therefor. (d.) Whether hemorrhoids were aggravated by any service-connected disorder or treatment therefor. Service connection is currently in effect for residuals of TBI with PTSD; migraine headaches; lumbar DDD with spondylosis and spondylolisthesis; right and left lower extremity radiculopathy; tinnitus; head injury residual scar; chronic gastritis/esophagitis with a history of a peptic ulcer, status-post surgical repair; bilateral hearing loss; and abdominal scars. The examiner’s attention is drawn to the following: *October 2010 VA examination report stating a history of hemorrhoids. *November 2011 VA examination report where the Veteran stated that he was diagnosed with internal hemorrhoids in 2007 and 2010 via colonoscopy and that he continued to have flare-ups. He stated that rectal pain with hard stools worsened while stationed in Southwest Asia. *July 2010, August 2010, May 2012, July 2012, and August 2012 VA treatment records indicating that the Veteran reported that hemorrhoids developed while stationed in Southwest Asia and caused rectal bleeding, and stating a diagnosis of hemorrhoids. VBMS Entries 5/16/2013, p. 8; 11/13/2019, p. 97, 181; and 11/13/2019, p. 77, 146. *October 2013 VA treatment record stating that the Veteran had a colonoscopy in April 2013 due to rectal bleeding and that he had internal hemorrhoids. VBMS Entry 11/13/2019, p. 19. *November 2018 statement from the Veteran that he had hemorrhoids and that they were caused or aggravated by his service-connected gastritis. VBMS Entry 11/13/2018. 6. Reassess the Veteran’s ratings for TBI with PTSD and for migraine headaches to determine whether vision loss and/or insomnia (1) are rated as part of those disorders, (2) whether they should be rated as part of those disorders, and (3) whether separate compensable ratings are warranted as part of the ratings for those disorders. (Continued on the next page)   7. Readjudicate the issues on appeal. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Miller, 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.