Citation Nr: 20029941 Decision Date: 04/28/20 Archive Date: 04/28/20 DOCKET NO. 17-62 552 DATE: April 28, 2020 ORDER New and material evidence having been received, the claim of service connection for hepatitis C is reopened. An initial rating higher than 10 percent for tinnitus is denied. A compensable initial rating for bilateral hearing loss is denied. An initial 40 percent rating for type II diabetes mellitus is granted. An initial 10 percent rating for prostate cancer is granted. Service connection for neuropathy of the bilateral upper extremities is denied. REMANDED Service connection for hepatitis C is remanded. Service connection for a right knee disorder is remanded. Service connection for a left knee disorder is remanded. Service connection for bilateral plantar fasciitis is remanded. Service connection for chronic bilateral pes planus is remanded. An earlier effective date for the grant of service connection for bilateral hearing loss is remanded. An earlier effective date for the grant of service connection for PTSD is remanded. An earlier effective date for the grant of service connection for tinnitus is remanded. An initial evaluation higher than 70 percent disabling for posttraumatic stress disorder (PTSD) with a cocaine-abuse disorder is remanded. A special monthly pension (SMC) based on the need for regular aid and attendance or at the housebound rate is remanded. A total rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACTS 1. In an unappealed March 2012 decision, the RO denied entitlement to service connection for hepatitis C. 2. The evidence added to the record since the March 2012 RO decision was not previously submitted to agency decision makers, is not cumulative or redundant and, by itself or when considered with the previous evidence of record, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim for service connection for hepatitis C. 3. The Veteran is currently assigned the maximum schedular rating for tinnitus. 4. For the entire period on appeal, the Veteran’s bilateral hearing loss was manifested by no worse than Level I hearing loss in the right ear and Level I hearing loss in the left ear. 5. The Veteran’s service-connected diabetes mellitus requires insulin, a regulation of his activities, and a restricted diet, with no showing of episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. 6. The Veteran’s prostate cancer, status post-radiation, in remission, results in daytime voiding intervals between two and three hours, nighttime awakening to void two times, and obstructed voiding in the form of a markedly weak stream. 7. Neuropathy of the bilateral upper extremities was not shown during active service or at any time thereafter. CONCLUSIONS OF LAW 1. The March 2012 rating decision that denied entitlement to service connection for hepatitis C is final. 38 U.S.C. § 7105(c); 38 U.S.C. § 20.1103. 2. New and material evidence has been received to reopen a claim of entitlement to service connection for hepatitis C. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for an initial rating greater than 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.87, DC 6260. 4. The criteria for a compensable initial rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.85, DC 6100. 5. The criteria for an initial 40 percent evaluation for diabetes mellitus have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.119, DC 7913. 6. The criteria for an initial 10 percent rating due to prostate cancer residuals have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.10, 4.115a, DC 7528. 7. The criteria for service connection for neuropathy of the bilateral upper extremities are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310(a), 3.326(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1970 to December 1971 and from February 1974 to November 1979. These matters are before the Board of Veterans’ Appeals (Board) on appeal from November 2016 and February 2018 rating decisions. It is noted that while the Veteran’s claim was in appellate status, a February 2019 rating decision granted service connection for right and left lower extremity peripheral neuropathy of the femoral nerve and right and left lower extremity peripheral neuropathy of the sciatic nerve. These issues are therefore no longer in appellate status and will not be addressed herein. 1. New and material evidence having been received, the claim of service connection for hepatitis C is reopened. The Veteran petitions to reopen his previously denied service connection claim for hepatitis C. For the following reasons, the Board finds reopening is warranted. Service connection for hepatitis C was previously denied in a March 2012 rating decision because the evidence did not show a nexus between current hepatitis C and active service. The Veteran was notified of the March 2012 rating decision and of his appellate rights by a letter dated March 26, 2012. He did not submit a notice of disagreement or initiate an appeal. See 38 C.F.R. §§ 20.200, 20.201, 20.302 (2018) (setting forth requirements and timeframe for perfecting an appeal). Moreover, new and material evidence was not of record within one year of this decision. See 38 C.F.R. § 3.156(b); Young v. Shinseki, 22 Vet. App. 461, 466 (2009) (holding that new and material evidence received within one year of an RO decision prevents that decision from becoming final); see also 38 C.F.R. § 3.400(q) (2018) (providing that, as to new and material evidence received within appeal period, “effective date will be as though the former decision had not been rendered”). Accordingly, the March 2012 rating decision is final. See 38 U.S.C. § 7105(c); 38 U.S.C. § 20.1103. In order to reopen a previously and finally disallowed claim, new and material evidence must be submitted by the claimant or secured by VA with respect to that claim since the last final denial. See 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273, 282-3 (1996) (holding that § 5108 requires a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened). VA regulation defines “new and material evidence” as follows. “New evidence” means evidence not previously submitted to agency decision makers, and “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. 38 C.F.R. § 3.156 (a). The new evidence must neither be 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. Id.; see Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (holding that there is a “low threshold” for reopening). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1994); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Veteran now contends service connection is warranted for hepatitis C secondary to PTSD. In a March 2019 correspondence, the Veteran’s representative highlights a statement from the Veteran who recalls turning to drugs in order to self-medicate and that this drug use resulted in his current liver condition. The Board observes the Veteran is now service-connected for PTSD with a cocaine-abuse disorder and finds the additional evidence is new and material that serves to reopen the claim. Increased Ratings VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. § Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 125; 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim, or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 2. A rating higher than 10 percent for tinnitus is denied. The Veteran is currently assigned a 10 percent rating for tinnitus under DC 6260, which only provides for a 10 percent rating, and a higher percentage is not available anywhere else in the rating schedule for tinnitus. Tinnitus is “a noise in the ear, such as ringing, buzzing, roaring, or clicking.” See Dorland’s Illustrated Medical Dictionary 1956 (31st ed. 2007). In October 2016, the Veteran did not report any functional impact of his tinnitus. The report notes his bilateral tinnitus happens several times a week. At his November 2018 examination, the Veteran reported tinnitus bilaterally and that he notices it two to three time a month. He also reported his tinnitus affects his concentration. The Veteran is currently assigned the maximum 10 percent rating for his tinnitus under 38 C.F.R. § 4.87, DC 6260. His tinnitus symptoms are inherently addressed by the 10 percent rating assigned under DC 6260. Neither the Veteran nor his representative has put forth an argument for why a higher rating is warranted, nor has a basis for a higher rating been otherwise raised by the record. There has been no assertion that an extraschedular rating is warranted, and no other bases for an extraschedular rating have been reasonably raised by the record. Therefore, the claim is denied. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. A compensable initial rating for bilateral hearing loss is denied. The Veteran has requested a rating higher than 0 percent for his bilateral hearing loss. His bilateral hearing loss has been assigned a 0 percent rating, effective April 12, 2016. For the following reasons, the Board finds the criteria for a compensable rating have not been satisfied. Hearing loss is evaluated under 38 C.F.R. § 4.85, DC 6100. In evaluating service-connected hearing loss, disability ratings are derived from a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85. To evaluate the degree of disability from defective hearing, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. §§ 4.85, Tables VI and VII, DC 6100. An exceptional pattern of hearing impairment occurs when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In exceptional situations, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). An October 2016 VA examination reflects the Veteran exhibited puretone thresholds, in decibels, as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 20 50 55 LEFT 30 20 25 45 55 The October 2016 VA examination report shows that based on audiometric and speech discrimination testing, the Veteran’s right ear hearing loss was manifested by a puretone threshold average of 38 decibels and a speech discrimination score of 100 percent. His left ear hearing loss was manifested by a puretone threshold average of 36 decibels and a speech discrimination score of 98 percent. Applying these values for the right ear to Table VI, the puretone threshold average of 38 dB and the speech recognition score of 100 percent together yield a designation of Level I for the right ear. The puretone threshold average of 36 dB and the speech recognition score of 98 percent yield a designation of Level I for the left ear. The point where designations I and I intersect in Table VII yields a 0 percent rating. See id. The Board notes the alternative criteria under 38 C.F.R. § 4.86(a) and 38 C.F.R. § 4.86(b) do not apply in this case as the Veteran has not been found to meet the criteria for an exceptional pattern of hearing impairment. See 38 C.F.R. § 4.86. During his November 2018 VA examination, the Veteran reported he experiences a difficulty hearing at a distance. He exhibited puretone thresholds, in decibels, as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 25 40 45 LEFT 20 20 25 45 50 The November 2018 VA examination report shows that based on audiometric and speech discrimination testing, the Veteran’s right ear hearing loss was manifested by a puretone threshold average of 31 decibels and a speech discrimination score of 100 percent. His left ear hearing loss was manifested by a puretone threshold average of 35 decibels and a speech discrimination score of 98 percent. Applying these values for the right ear to Table VI, the puretone threshold average of 31 dB and the speech recognition score of 100 percent together yield a designation of Level I for the right ear. The puretone threshold average of 35 dB and the speech recognition score of 98 percent yield a designation of Level I for the left ear. The point where designations I and I intersect in Table VII yields a 0 percent rating. See id. The Board notes the alternative criteria under 38 C.F.R. § 4.86(a) and 38 C.F.R. § 4.86(b) do not apply in this case as the Veteran has not been found to meet the criteria for an exceptional pattern of hearing impairment. See 38 C.F.R. § 4.86. The functional effects of hearing loss on the Veteran’s daily life activities and occupational functioning have been discussed by the Veteran at his VA examinations and have been taken into consideration by VA. See 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007). The Board acknowledges the Veteran’s belief that his hearing acuity is worse than evaluated. See November 2017 VA Form 9. However, far more probative of the degree of the disability are the results of testing prepared by a skilled professional since the schedular criteria are predicated on audiological findings rather than subjective reports of severity of hearing loss. In essence, lay statements are of limited probative value. As a layperson, the Veteran is competent to report difficulty with his hearing; however, he is not competent to assign particular speech recognition scores or puretone decibel readings to his current acuity problems. As indicated above, ratings of hearing loss disability involve mechanical application of the rating criteria to the findings on official audiometry. Lendenmann, 3 Vet. App. at 345. Furthermore, a review of the examination report indicates the examiner performed a complete and thorough examination, and nothing indicates the examination results are inadequate. A review of the report reflects the examiner followed the instructions on the Disability Benefits Questionnaire. Thus, the Board finds the examination is adequate. The Board sincerely empathizes with the Veteran and acknowledges he has a hearing loss that has caused him inconvenience and challenges in his daily life. However, when a claimant’s hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). As the situations described by the Veteran result from his difficulty or inability to hear or understand speech or other sounds, they do not establish an exceptional or unusual disability picture. His hearing impairment is not shown to be more severe than what is contemplated by the rating criteria. Further, the Veteran’s feelings of not being able to enjoy normal conversations, alone or in conjunction with his other hearing loss symptoms, are not shown to cause marked interference with employment, frequent periods of hospitalization, or any other related factors. Accordingly, his hearing loss does not constitute an exceptional or unusual disability picture. Thus, the Board will not refer the claim for extraschedular consideration. See 38 C.F.R. § 3.321(b); Thun v. Peake, 22 Vet. App. 111, 116 (2008); Chudy v. O’Rourke, 30 Vet. App. 34, 37-38 (2018). In sum, because the preponderance of the evidence weighs against a rating higher than 0 percent, entitlement to a compensable evaluation for the Veteran’s hearing loss is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. An initial 40 percent rating for type II diabetes mellitus is granted. The Veteran’s service-connected diabetes mellitus is currently assigned a 20 percent evaluation from April 26, 2010, pursuant to 38 C.F.R. § 4.119, DC 7913. His application for an increased evaluation was received on April 12, 2016. Under that DC, a 20 percent disability evaluation is assigned for diabetes mellitus requiring insulin and a restricted diet; or, an oral hypoglycemic agent and a restricted diet. A 40 percent disability evaluation is contemplated for diabetes mellitus requiring insulin, a restricted diet, and a regulation of activities. A 60 percent disability evaluation is warranted for diabetes mellitus requiring insulin, a restricted diet, and a regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent evaluation is contemplated for diabetes mellitus requiring more than one daily injection of insulin, a restricted diet, and a regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus progressive loss of weight and strength or complications that would be compensable if separately evaluated. The Court has held that, in order to demonstrate a regulation of activities, the “medical evidence” is required to show that both occupational and recreational activities have been restricted. Camacho v. Nicholson, 21 Vet. App. 360, 364 (2007). The phrase “regulation of activities” means “avoidance of strenuous occupational and recreational activities.” Camacho, 21 Vet. App. at 362 (quoting 38 C.F.R. § 4.119, DC 7913 (defining the term within the criteria for a 100 percent rating)). Successive rating criteria, such as DC 7913, is where the evaluation for each higher disability rating includes the criteria of each lower disability rating, such that if a component is not met at any one level, the veteran can only be rated at the level that does not require the missing component. Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009). For example, the diagnostic code for diabetes mellitus (DC 7913) is successive because each higher evaluation requires the elements of the lower evaluation: the 10 percent evaluation requires a restricted diet; the 20 percent evaluation requires a restricted diet and insulin or an oral hypoglycemic agent, the 40 percent evaluation requires insulin, a restricted diet, and a regulation of activities; and so forth. Camacho, 21 Vet. App. at 366. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes the Veteran is entitled to an increased evaluation for his service-connected type II diabetes mellitus. A December 2018 VA examination report shows the Veteran’s diabetes mellitus requires more than one injection per day of insulin and a regulation of activities. The frequency of diabetic care for episodes of ketoacidosis or hypoglycemic reactions is noted to be less than twice per month. No hospitalizations were documented. No unintentional weight loss or loss of strength attributable to diabetes mellitus was found. Complications of the Veteran’s diabetes mellitus were found to include diabetic peripheral neuropathy of the lower extremities and an erectile dysfunction. The Veteran is currently service connected for right lower extremity peripheral neuropathy of the femoral nerve, left lower extremity peripheral neuropathy of the femoral nerve, right lower extremity peripheral neuropathy of the sciatic nerve, and left lower extremity peripheral neuropathy of the sciatic nerve – all associated with his service-connected diabetes mellitus. Regarding the Veteran’s erectile dysfunction, which has been found to be secondary to prostate cancer, the Board notes he has already been assigned special monthly compensation under 38 U.S.C. § 1114 (k) (2012), for loss of use of a creative organ. To receive additional compensation for his erectile dysfunction, there must be manifestations of additional symptomatology such as deformity of the penis, atrophy of the testis, infections of the prostate gland, or epididymo-orchitis. See 38 C.F.R. § 4.115 (b), DCs 7522, 7523, 7525, 7527 (2018). Although the December 2018 VA examination report found the Veteran does not require a restricted diet, his VA medical records note he is on a diabetic diet. For example, in April 2016, a diabetic diet was noted. The Veteran was instructed on a diabetic diet, and a diabetic diet was again noted in June 2016. In January 2019, his diet was reviewed, and he was again educated on his diet. Accordingly, the Board finds the Veteran has required a restricted diet for the entire appeal period. A 40 percent evaluation requires all of the following: insulin, a restricted diet, and a regulation of activities. 38 C.F.R. § 4.119, DC 7913. There is no evidence of any other service-connected diabetic complications. Indeed, the evidence of record does not show any other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran’s service-connected diabetes mellitus. The examiner assessed the Veteran for complications that might arise from the Veteran’s type II diabetes mellitus. For example, the examiner found there has been no weight change due to the Veteran’s type II diabetes, no eye conditions were found, etc. Apart from diabetic peripheral neuropathy of the lower extremities and erectile dysfunction, for which he is now service connected, the December 2018 examination report does not show any other physical findings, complications, conditions, signs, or symptoms related to the Veteran’s type II diabetes mellitus. Based on the foregoing, the Veteran has been shown to meet the criteria for an increased evaluation under the rating criteria. Accordingly, the Veteran is entitled to an evaluation of 40 percent for his diabetes mellitus as his service-connected diabetes mellitus requires insulin, a restricted diet, and a regulation of activities. 5. An initial compensable rating for prostate cancer is granted. In a February 2019 statement, the Veteran’s representative contends the Veteran’s prostate cancer residuals warrant a 10 percent rating. For the reasons below, the Board agrees. Service connection for prostate cancer was granted by a rating decision dated in February 2018. The disability was assigned a noncompensable rating, effective August 28, 2017, the date the Veteran’s intent to file was received, under DC 7528. 38 C.F.R. § 4.115b. DC 7528 provides that when a veteran’s cancer goes into remission, the veteran is to be rated based on the residuals of the cancer. The Note under DC 7528 states that following the cessation of surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedure, any change in evaluation based on examination shall be subject to the provisions of 38 U.S.C. § 3.105 (3) of this chapter. If there has been no local recurrence or metastasis, rate on the residuals as voiding dysfunction or renal dysfunction, whichever is predominant. 38 C.F.R. § 4.115b, DC 7528. The Veteran was afforded a VA examination in November 2018. The examination report notes the Veteran was diagnosed with prostate cancer in 2015 and that his prostate cancer is in remission. The Veteran reported that his condition had worsened due to an erectile dysfunction and due to an increase in urinary frequency and urgency. On examination, a voiding dysfunction was noted. The voiding dysfunction was found not to cause urine leakage or require the use of an appliance. It was, however, found to result in an increase in urinary frequency. Specifically, the report notes the Veteran has daytime voiding intervals between two and three hours and nighttime awakening to void two times. Obstructed voiding in the form of a markedly weak stream was documented. The examiner found no urinary tract infection, kidney infection, or retrograde ejaculation. Residual conditions or complications were noted to include testicular discomfort when the Veteran crosses his legs. Erectile dysfunction was found secondary to the Veteran’s prostate cancer. However, as noted elsewhere, he is already assigned special monthly compensation under 38 U.S.C. § 1114 (k) (2012) for loss of use of a creative organ. To receive additional compensation for his erectile dysfunction, there must be manifestations of additional symptomatology, such as deformity of the penis, atrophy of the testis, infections of the prostate gland, or epididymo-orchitis. See 38 C.F.R. § 4.115 (b), DCs 7522, 7523, 7525, 7527 (2018). The Board further observes the Veteran also experiences obstructed voiding in the form of a weak stream. A 10 percent rating is allowed for obstructed voiding when any one or combination of the listed four types of symptomatology are found, which includes a markedly diminished peak flow rate. See 38 C.F.R. § 4.115a. As noted above, the Veteran is now in receipt of a 10 percent disability rating for his voiding dysfunction. Regarding this, the Rating Schedule specifically provides a prohibition against pyramiding, and the rating of the same manifestation under different diagnoses is to be avoided. 38 C.F.R. § 4.14. Although there are two separate conditions – voiding dysfunction and obstructed voiding – the prohibition against pyramiding allows only a single rating for the overlapping symptoms. Both issues are considered part of the genitourinary system. The assignment of separate ratings for urine leakage, urinary frequency, or obstructed voiding would be pyramiding and is not permissible under 38 C.F.R. § 4.14. Therefore, the Veteran is not entitled to separate evaluations for his prostate cancer residuals, as this would violate the anti-pyramiding regulation. See 38 C.F.R. § 4.14. Based on the evidence demonstrating the Veteran experiences daytime voiding intervals between two and three hours and nighttime awakening to void two times, the Board finds an initial 10 percent rating for prostate cancer residuals under Diagnostic Code 7528 is warranted for urinary frequency, which has manifested as a daytime voiding interval between one and two hours and awakening to void two times per night. Accordingly, the claim for an initial compensable rating for residuals of prostate cancer is granted. 6. Service connection for neuropathy of the bilateral upper extremities is denied. Service connection may be granted for a disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310 (a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran asserts he has neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus. See April 2016 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. The record does not reflect that the Veteran has been found to have neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus at any time. The report of a December 2018 VA diabetes mellitus examination notes no such diagnosis. The report, however, found neuropathy of the lower extremities secondary to his service connected type II diabetes mellitus for which the Veteran is now service connected. Service connection requires a showing of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A current disability is shown if the claimed condition is demonstrated at the time of the claim or while the claim is pending. McClain v. Nicholson, 21 Vet. App. 319 (2007). Though the Veteran contends he has neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus, no current disability has been shown. Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran’s claim is supported solely by his own statements on appeal. He is competent to state that he experiences neurological symptoms. However, the Board finds his lay statements that such symptoms are attributable to diabetic neuropathy do not constitute competent evidence of the existence of diabetic neuropathy of the upper extremities. A medical professional has found no neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus. The Veteran has not offered any medical qualifications. As a result, he is not competent to offer an opinion regarding the diagnosis of neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus. The diagnosis of the claimed disorder is not amenable to observation by a lay person and requires specific clinical testing and correlation. It is too complex to be addressed by a layperson. In sum, the Veteran has not been shown to have neuropathy of the upper extremities secondary to his service connected type II diabetes mellitus at any time. In the absence of current disability, the Board finds service connection may not be granted. REASONS FOR REMAND 1. Service connection for hepatitis C, to include as due to PTSD, is remanded. The Veteran’s treatment records reflect a diagnosis of hepatitis C viral cirrhosis. The Veteran maintains that hepatitis C is related to his active service in that he contracted it as a result of his need to cope with stressors and psychiatric symptoms he experienced during active service. Specifically, the Veteran notes he began using cocaine intravenously and intranasally, which he believes put him at risk of contracting hepatitis C. See Veteran’s November 2018 statement. Moreover, he contends that hepatitis C is secondary to his service-connected PTSD. He has not been afforded a VA examination to address these issues; as such, a remand is warranted.   2. Service connection for a right knee disorder is remanded. 3. Service connection for a left knee disorder is remanded. The Veteran’s post-service medical records reflect a history of chronic knee disorders. For example, an August 2010 treatment report notes arthritis and swelling of the right knee with a longstanding history of such flare-ups. In October 2012, the Veteran reported having had fluid drained from his knees “a long time ago.” He further stated having had left knee pain “for years” while receiving treatment in March 2009. The Veteran’s CAPRI records also note treatment for bilateral knee degenerative joint disease. Based on the foregoing medical and lay evidence of record, the Board finds the threshold has been met to warrant providing the Veteran a VA examination to obtain an opinion regarding the etiology of his bilateral knee condition. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board also observes the Veteran’s VA treatment records note he received medical treatment while he was incarcerated with the Texas Department of Criminal Justice. No such medical records are currently of file. As a result, a remand is also required to attempt to obtain these outstanding treatment records. 4. Service connection for bilateral plantar fasciitis is remanded. 5. Service connection for chronic bilateral pes planus is remanded. A Veteran is presumed to have been in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at the time of examination, acceptance, enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304 (2018). To rebut the presumption of soundness the burden is on VA to satisfy a two-prong test by showing “... by clear and unmistakable evidence both that (1) the Veteran’s disability existed prior to service and (2) that the preexisting disability was not aggravated during service.” See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). VA may rebut the second prong of the presumption of soundness “... through demonstrating, by clear and unmistakable evidence, either that (1) there was no increase in disability during service, or (2) any increase in disability was due to the natural progression of the condition.” Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009) (citing Wagner, 370 F.3d at 1096). This burden must be met by “affirmative evidence” demonstrating that there was no aggravation. Horn v. Shinseki, 25 Vet. App. 231, 235 (2012). Conversely, the burden is not met by finding “that the record contains insufficient evidence of aggravation.” Id. Regarding the Veteran’s claim of service connection for chronic bilateral pes planus, military personnel records dated February 1970 note: “claims fallen arches -- not verified.” His February 1970 pre-induct Report of Medical Examination notes normal feet on examination. The Board observes that only such conditions as are recorded in entrance examination reports are considered to be “noted” for purposes of the presumption of soundness, as a “history of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions.” 38 C.F.R. § 3.304 (b)(1)(2018); see also Crowe v. Brown, 7 Vet. App. 238, 245 (1994). Therefore, the Veteran is entitled to the presumption of soundness. The Veteran is claiming service connection for bilateral plantar fasciitis and service connection for bilateral pes planus. The VA obtained an examination in November 2016. The Veteran was diagnosed with bilateral pes planus and bilateral plantar fasciitis. Regarding the etiology of the Veteran’s bilateral foot conditions, the examiner’s November 2016 negative opinion simply states, “No foot complaints were found in [the] medical record.” The Board finds the opinion to be inadequate because the Veteran’s October 1979 discharge medical examination notes a finding of abnormal feet. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (indicating an opinion based on an incorrect factual premise has no probative value). Furthermore, the examination report does not note the existence or absence of lay evidence that could show a chronicity of symptoms or whether the Veteran had any foot symptoms during the decades since separation from active service. VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Accordingly, this opinion is inadequate to evaluate the claim, and a new examination and opinion are warranted. 6. An earlier effective date for the grant of service connection for bilateral hearing loss is remanded. 7. An earlier effective date for the grant of service connection for PTSD is remanded. 8. An earlier effective date for the grant of service connection for tinnitus is remanded. In November 2016, the RO granted the Veteran’s claims of service connection for bilateral hearing loss, service connection for PTSD, and service connection for tinnitus. The Veteran filed a timely Notice of Disagreement in July 2017 disagreeing with the effective dates of those claims in the November 2016 rating decision. The RO has yet to issue a Statement of the Case (SOC) regarding the Veteran’s claims for earlier effective dates for service connection for bilateral hearing loss, service connection for PTSD, and service connection for tinnitus. As such, these claims must be remanded. See Manlincon v. West, 12 Vet. App. 238 (1999). 9. An initial evaluation higher than 70 percent disabling for posttraumatic stress disorder (PTSD) with a cocaine-abuse disorder is remanded. The Board notes it appears the Veteran was last afforded a VA examination to assess the severity of his service-connected PTSD disability in November 2016. VA treatment records from April 2018 show that the Veteran reported an increase in memory problems and that he left home but could not remember where he was going. Those treatment records also note the Veteran’s medication was increased in May 2017. As there is an indication the Veteran’s PTSD symptoms have increased in severity and to ensure the record reflects the current severity of his service-connected PTSD on appeal, a more contemporaneous examination is warranted. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (determining that Board should have ordered contemporaneous examination of Veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating); Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (holding that where the record does not adequately reveal the current state of that disability, the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination). 10. An SMC based on the need for regular aid and attendance or at the housebound rate is remanded. The issue of entitlement to SMC must be remanded as it is inextricably intertwined with the remanded issues of service connection. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when the adjudication of one issue could have “significant impact” on the other issue). 11. A TDIU due to service-connected disabilities is remanded. The Board notes the issue of entitlement to TDIU is inextricably intertwined with the other claims being remanded herein as the outcome of the service connection claims and the increased rating PTSD claim may impact the outcome of the TDIU claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The Veteran’s eligibility for a schedular TDIU may be impacted by the AOJ’s adjudication of the service connection claims being remanded as well as if a higher rating is deemed appropriate for his service-connected psychiatric disability. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, an SMC may be warranted if the Veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated at 100 percent. See Bradley, 22 Vet. App. 280. As a result, the Board will defer appellate consideration of the issue of entitlement to TDIU pending completion of the action requested below. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and any outstanding private medical records identified by the Veteran as pertinent to his claims. 2. Provide the Veteran with and ask him to complete the appropriate authorization forms necessary for release of his Texas Department of Criminal Justice treatment records. After securing the necessary releases, attempt to obtain and associate the Texas Department of Criminal Justice treatment records with the claims file. If any identified records cannot be obtained and further attempts would be futile, such should be noted in the claims file, and the Veteran should be notified so that he can make an attempt to obtain the records himself. 3. For the Veteran’s service connection claims for a liver condition, a left knee disorder, a right knee disorder; bilateral plantar fasciitis, and chronic bilateral pes planus, arrange for VA examinations and medical opinions regarding the nature and etiology of these conditions. The claims file must be made available to the examiner(s). All indicated tests should be conducted and all findings reported in detail. For each condition, the examiner(s) should elicit from the Veteran a complete history of his symptomatology, including any in-service symptomatology and treatment; as well as any post-service history of symptoms and treatment. Following a review of the entire record, to include the Veteran’s lay statements concerning onset and continuity of symptomatology, the examiner(s) should address the following questions: Hepatitis C or Any Liver Condition (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any hepatitis C or liver condition had a clinical onset during active service or is related to any incident of service. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any hepatitis C or liver condition was either (i) caused by or (ii) aggravated by his service-connected psychiatric disability. If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation The examiner should acknowledge and discuss the Veteran’s November 2018 statement, where he notes he turned to drugs and began using cocaine intravenously and intranasally, which he contends was a risk factor of contracting hepatitis C. Right Knee, Left Knee (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any right knee or left knee disorder had a clinical onset during active service or is related to any incident of service. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any right knee or left knee disorder was either (i) caused by or (ii) aggravated by his service-connected neuropathy of the bilateral lower extremities or by any other service-connected disability. If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation Bilateral Plantar Fasciitis (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) the Veteran’s bilateral plantar fasciitis had its clinical onset during active service or is related to any incident of service. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) the Veteran’s bilateral plantar fasciitis was either (i) caused by or (ii) aggravated by his service-connected neuropathy of the bilateral lower extremities or by any other service-connected disability. If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation Chronic Bilateral Pes Planus (a.) Did the Veteran’s bilateral pes planus, which was not noted upon entrance, see February 1970 pre-induct Report of Medical Examination, clearly and unmistakably (i.e., by a showing of obvious and manifest evidence) preexist the Veteran’s active service? (b.) If the answer to the above question is “YES,” was bilateral pes planus clearly and unmistakably (obvious and manifest) not aggravated beyond its normal progression during the Veteran’s active service? (c.) If the answer to question (a) is “NO,” is it at least as likely as not (i.e., a 50 percent or greater probability) bilateral pes planus had its onset in, or is otherwise related to his period of active duty service? (d.) If the answer to question (a) and (b) is “NO,” is at least as likely as not (50 percent or greater probability) the Veteran’s bilateral pes planus was either (i) caused by or (ii) aggravated by his service-connected neuropathy of the bilateral lower extremities or by any other service-connected disability? If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements regarding in-service incurrence and continuity of symptomatology. The examiner’s opinion must reflect consideration of the Veteran’s reports as to his history and symptomatology. If the examiner chooses to reject his reports, the examiner must provide a reason for doing so, and his lay statements must not be rejected due solely to an absence of contemporaneous or corroborating medical evidence, although this may be considered together with the other evidence of record. The examiner(s) must provide a comprehensive report including complete rationales for all opinions and conclusions reached. (Continued on the next page)   4. Schedule the Veteran for a VA examination to assess the current severity of his PTSD. The claims folder should be made available to and reviewed by the examiner. The examiner should identify all current manifestations of the Veteran’s PTSD, including any symptoms and resulting social and occupational impairment. 5. The AOJ should issue an SOC addressing the issues of entitlement to earlier effective dates for service connection for bilateral hearing loss, service connection for PTSD, and service connection for tinnitus. Thereafter, the Veteran should be given an opportunity to perfect an appeal by submitting a timely substantive appeal in response thereto. The AOJ should advise the Veteran that the claims file will not be returned to the Board for appellate consideration of this particular issue following issuance of the SOC unless he perfects his appeal. ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Buck Denton 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.