Citation Nr: 21004081 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 16-13 013 DATE: January 25, 2021 ORDER Entitlement to service connection for a right shoulder disorder is denied. Entitlement to service connection for a left shoulder disorder is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. Entitlement to service connection for an unspecified mental health disorder, currently diagnosed as depressive disorder with anxious distress features, is granted. Entitlement to service connection for sleep apnea is granted. Entitlement to service connection for headaches is granted. Entitlement to an effective date prior to March 26, 2013 for the grant of service connection for asthma is denied. Entitlement to an effective date prior to March 26, 2013 for the grant of service connection for hepatitis B is denied. Entitlement to an effective date prior to June 10, 2014 for the grant of service connection for hearing loss is denied. Entitlement to an effective date prior to June 10, 2014 for the grant of service connection for tinnitus is denied. Entitlement to an effective date prior to June 10, 2014 for the grant of service connection for superficial laceration scar below right eyebrow is denied. A disability rating of 60 percent for asthma is granted. Entitlement to a compensable disability rating for Hepatitis B is denied. Entitlement to a compensable rating for a bilateral hearing loss is denied. Entitlement to a disability rating in excess of 10 percent for tinnitus is denied. Entitlement to a disability rating in excess of 30 percent for a superficial laceration scar below the right eyebrow is denied. REMANDED Entitlement to service connection for an eye disorder, to include glaucoma, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a right shoulder disability began during active service or is otherwise related to an in-service injury or disease; arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established. 2. The preponderance of the evidence is against finding that a left shoulder disability began during active service or is otherwise related to an in-service injury or disease; arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established. 3. The Veteran’s hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is not otherwise etiologically related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that GERD began during active service or is otherwise related to an in-service injury or disease. 5. The Veteran’s depressive disorder with anxious distress was incurred in service. 6. The Veteran’s sleep apnea is aggravated beyond its natural progression by his service-connected asthma and psychiatric disabilities. 7. The Veteran’s headaches are aggravated beyond their natural progression by his service-connected asthma, tinnitus, and psychiatric disabilities. 8. The Veteran initially filed claims for entitlement to service connection for asthma and hepatitis B in March 2001; these claims were denied in a final August 2002 rating decision. 9. On March 26, 2013, the Veteran filed a petition to reopen the previous claims for entitlement to service connection for hepatitis and asthma. 10. On June 10, 2014, VA received the Veteran’s original claim for service connection for hearing loss, tinnitus, and an eye disorder. 11. Asthma has been manifested by pulmonary function tests reflecting pre-bronchodilator FEV-1 of 55 percent predicted. 12. Hepatitis B has not been manifested by intermittent fatigue, malaise, and anorexia, or incapacitating episodes. 13. The Veteran’s bilateral hearing loss has been manifested by hearing acuity of no worse than Level I in both ears. 14. The Veteran is assigned the maximum schedular rating for tinnitus. 15. The Veteran’s superficial laceration scar below the right eyebrow is not manifest by at least one characteristic of disfigurement. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a left shoulder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for GERD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for depressive disorder with anxious distress are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for sleep apnea as secondary to service-connected asthma and a psychiatric disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 7. The criteria for service connection for headaches as secondary to service-connected asthma, tinnitus, and a psychiatric disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 8. The criteria for an effective date prior to March 26, 2013, for the award of service connection for asthma, are not met. 38 U.S.C. §§ 5110; 38 C.F.R. §§ 3.400. 9. The criteria for an effective date prior to March 26, 2013, for the award of service connection for hepatitis B, are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 10. The criteria for an effective date prior to June 10, 2014, for the award of service connection for hearing loss, are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 11. The criteria for an effective date prior to June 10, 2014, for the award of service connection for tinnitus, are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 12. The criteria for an effective date prior to June 10, 2014, for the award of service connection for superficial laceration scar below right eyebrow, are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 13. The criteria for an increased disability rating of 60 percent, but no higher, for asthma are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6602. 14. The criteria for entitlement to a compensable disability rating for hepatitis B are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, DC 6602. 15. The criteria for a compensable rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, DC 6100. 16. The criteria for an initial rating higher than 10 percent for service-connected tinnitus are not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, Diagnostic Code 6260. 17. The criteria for a compensable disability rating for superficial laceration scar below the right eyebrow are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7800. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1974 to June 1978, from February 1982 to May 1984 and from July 1986 to April 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from March 2014 and November 2014 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Claims Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Right and Left Shoulder Disorders The Veteran contends that service connection is warranted for right and left shoulder disorders. The question for the Board is whether the Veteran has a current right or left shoulder disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds that service connection is not warranted for disabilities of the right and left shoulders. Service treatment records do not show any treatment for or a diagnosis of a left shoulder disability. A November 1975 service treatment record reflects that the Veteran’s right shoulder was hit by a tailgate and was swollen. There was no diagnosis of a right shoulder disorder, and he was treated with ice packs and told to return for reevaluation. There is no record of the Veteran returning to the clinic. Separation Reports of Medical Examination for the Veteran’s three periods of duty are negative for shoulder disabilities. On his Separation Reports of Medical History, the Veteran denied shoulder problems. The Veteran was provided with a VA examination in November 2014. The examiner diagnosed bicipital tendonitis in the right shoulder, a rotator cuff tear in the left shoulder, and acromioclavicular joint osteoarthritis in both shoulders. The Veteran reported that he began having pain in his right shoulder following left shoulder surgery in 2013. He denied injury to the right shoulder. He reported that he underwent rotator cuff repair on the left shoulder in February 2013 and had not had any left shoulder problems since the surgery. The examiner opined that the Veteran’s right and left shoulder disabilities were less likely as not related to service. With regard to the right shoulder, the examiner noted that the Veteran’s was only seen once for his in-service injury and was treated conservatively. The examiner opined that the right shoulder pain, which resolved and was no longer a problem, was likely due to a shoulder strain, which would affect the soft tissue around the joint and not the joint itself and would self-resolve over time. X-rays revealed completed at the time of the examination revealed minimal degenerative joint disease of both shoulders. The examiner found that the fact that the degenerative joint disease was minimal in both shoulders suggested that it was a recent development and was more likely related to the age as the Veteran. If degenerative joint disease of the right shoulder was due to the injury sustained in 1975 the examiner expected that it would be much worse than the left shoulder, which was not the case for the Veteran. The Board concludes that, while the Veteran has current diagnoses of right and left shoulder disabilities, the preponderance of the evidence weighs against finding that these disabilities began during service or are otherwise related to an in-service injury, event, or disease. While the Veteran is competent to report having experienced symptoms of pain, he did not contend that he has had shoulder pain since service. The Veteran does not have the medical expertise to provide an opinion that his current disabilities are related to service. The issue is medically complex, as it requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The November 2014 VA examiner opined that the Veteran’s right and left shoulder disabilities are not at least as likely as not related to an in-service injury, event, or disease, including his right shoulder injury in 1975. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported with a reasoned medical explanation that is consistent with the Veteran's treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). The examiner’s opinion is supported with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As the does not support a finding that the Veteran’s right or left shoulder disabilities are etiologically related to service, service connection on a direct basis is not warranted. The Veteran has a current diagnosis of arthritis, which is considered a chronic condition and could be awarded presumptive service connection if the evidence were to show that it was chronic in service, manifested to a compensable degree within a year following separation from service, or if it was noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. However, in this case, there is no evidence to support that the Veteran’s degenerative joint disease was chronic in service. The evidence does not show, and the Veteran has not argued, that he had chronic shoulder problems in service. In addition, the evidence does not reflect that his shoulder arthritis manifested to a compensable degree following service. It was determined to be mild in 2014—24 years after his most recent discharge from active duty. In addition, the Veteran has not reported ongoing symptoms since service. As such, service connection on a presumptive bases for right and left shoulder arthritis is not warranted. 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claims, the doctrine is not for application. 38 C.F.R. § 3.102. Hypertension The Veteran contends that his hypertension is related to service. The Veteran has a current diagnosis of hypertension as evidenced ongoing VA medical records. Hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Hypertension was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Service treatment records do not reflect treatment for or complaints of hypertension. VA treatment records show the Veteran was not diagnosed with hypertension until 2002, over a decade after his separation from service and at least a decade outside of the applicable presumptive period. There is no medical evidence linking this diagnosis to service. While the Veteran’s claim reflects his belief that his currently diagnosed hypertension warrants service connection, he has not provided any specific contentions as to how his hypertension is linked to service or that it was been present since service. The Board does note that the Veteran is competent to report having experienced symptoms of hypertension; however he not competent to provide an opinion regarding etiology. The issue is medically complex, as it requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence of record, the Board finds that the claim must be denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 C.F.R. § 3.102. GERD The Veteran contends that his GERD is related to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds that, while the Veteran has a current diagnosis of GERD, the preponderance of the evidence weighs against finding that the Veteran’s GERD began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records do not reflect treatment for or complaints of reflux or GERD. VA medical records beginning in 2001 do reflect that the Veteran had a diagnosis of GERD; however, there is no medical evidence linking this diagnosis to service. While the Veteran’s claim reflects his belief that his currently diagnosed GERD warrants service connection, he has not provided any specific contentions as to how his GERD is linked to service or an explanation as to why service connection is warranted. The Board does note that the Veteran is competent to report having experienced symptoms of GERD, however he not competent to provide an opinion regarding etiology. The issue is medically complex, as it requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence of record, the Board finds that the claim must be denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 C.F.R. § 3.102. Psychiatric Disorder The Veteran contends that he has a psychiatric disability that began during service. The Board concludes that the Veteran has a current psychiatric disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service treatment records reflect that when the Veteran was diagnosed with hepatitis B, in December 1987, during his final period of active duty, he was also diagnosed with anxiety related to this diagnosis. May 2002 VA medical records reflect the Veteran’s reports that he had a history of depression and anxiety. At that time, he was diagnosed with dysthymia with anxiety. The Veteran submitted a letter from his aunt dated September 2016. She relayed her observations of the changes she saw in the Veteran upon his return from active duty. She reported that, once the Veteran returned from service, he isolated himself and did not attend family events. He became angry easily and indicated that he struggled with anxiety and had trouble sleeping. He reported flashbacks and nightmares. The Veteran submitted a Mental Disorders Disability Benefits Questionnaire (DBQ) dated in October 2016 completed by a private provider. The provider diagnosed the Veteran with depressive disorder with anxious distress features aggravated by medical conditions. The Veteran indicated that he did not have any psychiatric difficulties or symptoms prior to service He reported that he had experienced some grief and loss over deaths that occurred with family and friends since service which had worsened his depressive symptoms at times, but he confirmed that the root cause of his depression began in service and that they were further aggravated by his medical problems. The private provider included a psychiatric assessment with the completed DBQ form. He opined that the Veteran presented with symptoms of a depressive disorder which more likely than not began during service and continued uninterrupted to the present. The examiner also opined that this depressive disorder was more likely than not aggravated by his service-connected stated medical conditions. The Board finds this opinion to be highly probative and persuasive, as it is based on a review of the evidence of record and supported with a reasoned medical explanation that is consistent with the Veteran's treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ( [A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions ). The Board finds that, resolving all reasonable doubt in favor of the Veteran, service connection for his psychiatric disability is warranted on a direct basis. While the examiner has also indicated that his service-connected medical disabilities have aggravated his psychiatric disability, because ratings for disabilities aggravated by service-connected disabilities are determined by deducting the baseline level of severity and any natural progress of the disease from the current level, see 38 C.F.R. § 3.310(b), service-connection on the basis of secondary aggravation is considered a lesser benefit than direct service connection and service connection on the basis of secondary causation, which involve no such deduction. In this case, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current psychiatric disability arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for depressive disorder with anxious distress features on a direct basis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Sleep Apnea The Veteran contends that his sleep apnea is secondary to service-connected disabilities. Medical evidence of record shows that the Veteran has a current diagnosis of sleep apnea. See November 2016 Sleep Apnea DBQ. The Veteran provided a private sleep apnea DBQ and opinion dated in November 2016. The private provider opined that based on his experience, interview with the Veteran, review of the medical records, and supporting literature, it was as likely as not that his service-connected asthma and his depressive disorder aggravated his obstructive sleep apnea. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported with a reasoned medical explanation that is consistent with the Veteran's treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). There are no opinions that weigh against the Veteran’s claim. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current sleep apnea is aggravated beyond its natural progression by his service-connected asthma and psychiatric disabilities. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Headaches The Veteran contends that his headaches are secondary to service-connected disabilities. Medical evidence of record shows that the Veteran has a current diagnosis of migraines. See November 2016 headaches DBQ. The November 2016 private headaches DBQ and opinion reflected the private provider’s opinion that the Veteran’s headaches were caused by his service-connected asthma and tinnitus as well as his depressive disorder. The private provider noted that the Veteran reported that when he had an asthma flare, it would bring on a headache. The private provider opined that based on his experience, interview with the Veteran, review of the medical records, and supporting literature, it was as likely as not that the Veteran’s service-connected asthma, tinnitus, and depressive disorder have caused and permanently aggravate his migraines. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported with a reasoned medical explanation that is consistent with the Veteran’s treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). There are no opinions that weigh against the Veteran’s claim. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current headaches are aggravated beyond the natural progression by his service-connected asthma, tinnitus, and psychiatric disabilities. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for headaches is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Effective Dates Unless specifically provided otherwise, the effective date of an award of compensation shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (b)(2). There is no provision in the law for awarding an earlier effective date based simply on the presence of the disability, and the mere presence of medical evidence of a condition does not establish intent on the part of the Veteran to seek service connection. Brannon v. West, 12 Vet. App. 32, 35 (1998). An effective date for a reopened claim of entitlement to service connection can be no earlier than the date the request to reopen the claim was filed. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (q)(1)(ii); see also Jones v. Shinseki, 619 F.3d 1368, 1371 (Fed. Cir. 2010) (noting for an award based on a claim reopened after a final adjudication, the effective date is typically the date that the request to reopen was filed). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments also, inter alia, eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 38 C.F.R. §§ 3.151, 3.155, 3.157. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Effective Date – Service Connection for Asthma and Hepatitis B The Veteran initially filed a claim for entitlement to service connection for asthma and hepatitis B in March 2001. The RO denied the claims in an August 2002 rating decision. He did not file a notice of disagreement within one year of notice of the August 2002 rating decision and no additional evidence was received within one year of notice of the decision. For this reason, the August 2002 rating decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. The next communication relating to asthma and hepatitis B is the claim for entitlement to service connection filed on March 26, 2013. These claims were granted in the March 2014 rating decision on appeal here, which assigned the effective date as the date of claims—March 26, 2013. Between August 2002, and March 26, 2013, there is no communication that may serve as an informal or formal claim for benefits for asthma or hepatitis B. The Board notes the Veteran’s representative has not offered any argument in support of his client's position on this issue. There being no reasonable doubt to resolve in the Veteran’s favor, the claims for earlier effective dates for the grant of service connection for asthma and hepatitis B must be denied. Effective Date - Service Connection for Hearing Loss and Tinnitus The Veteran filed a claim for entitlement to service connection for tinnitus only on February 11, 2014. On June 10, 2014, he filed a claim for, among other things, hearing loss and tinnitus. A November 2014 VA examination report reflects the examiner’s opinion that the Veteran’s tinnitus was at least as likely as not (50% probability or greater) a symptom associated with the hearing loss, as tinnitus was known to be a symptom associated with hearing loss. In a November 2014 rating decision the Veteran was awarded service connection for bilateral hearing loss and tinnitus, both effective June 10, 2014. The Board finds that earlier effective dates are not warranted for hearing loss or associated tinnitus. The preponderance of the evidence shows the Veteran did not file either an informal or a formal claim for hearing loss prior to June 10, 2014. His prior claims were not general in nature and would not be interpreted as claim for hearing loss. Cf. Sellers v. Wilkie, 30 Vet. App. 157, 161 (2018). As such, an effective date prior to June 10, 2014 is not warranted because there is no communication that may serve as an informal or formal claim for benefits that was received prior to such time. The Board acknowledges that the Veteran did file his initial claim for service connection for tinnitus on February 11, 2014; however, tinnitus was service-connected based on medical evidence that it was a symptom of hearing loss. While a secondary condition may have onset before the effective date of the award for service connection for or diagnosis of the primary condition, the effective date of a secondarily service-connected disability is precluded from being before the effective date of the primary service-connected disability. See Frost v. Shulkin, 29 Vet. App. 131 (2017); see also, Ellington v. Peake, 541 F. 3d 1364, 1369-70 (Fed. Cir. 2008) (noting that effective dates for primary and secondary conditions are afforded the same treatment under 38 C.F.R. § 3.400 and that secondary conditions arise at the same time or after primary conditions). This is such, because to establish secondary service connection, it must be secondary to a condition that is already service-connected. In this case, while tinnitus was determined to be a symptom of hearing loss, and not secondary to it as contemplated by the regulations pertaining to service connection on a secondary basis, the same tenet applies here. Service connection was granted for tinnitus based on the medical opinion that it was a symptom of hearing loss. As such, service connection cannot be granted for tinnitus as effective prior to the grant of service connection for hearing loss. There being no doubt to resolve in the Veteran’s favor, the claims for effective dates prior to June 10, 2014 for hearing loss and tinnitus must be denied. Effective Date - Service Connection for Superficial Laceration Scar Below Right Eyebrow The Veteran was granted service connection for a scar below his right eyebrow in a November 2014 rating decision. The RO noted that the Veteran had not filed a claim for a scar, but that the evidence of record reflected that it was related to service and assigned an effective date of June 10, 2014 based on the date the Veteran filed his claim for an eye disability. The Board has reviewed the record and found that the preponderance of the evidence shows the Veteran did not file either an informal or a formal claim for any type of eye disability prior to June 10, 2014. His prior claims were not general in nature and would not be interpreted as claim for an eye disability, to include a scar. Cf. Sellers v. Wilkie, 30 Vet. App. 157, 161 (2018). As such, an effective date prior to June 10, 2014 is not warranted because there is no communication that may serve as an informal or formal claim for benefits that was received prior to such time. Increased Rating Claims Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. Asthma The Veteran’s asthma has been rated under Diagnostic Code 6602 at a 30 percent disability rating since March 26, 2013. He contends that his asthma should be at a higher rating. Under Diagnostic Code 6602, bronchial asthma is assigned a 30 percent rating with the following pulmonary function test results: FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent rating is available where pulmonary function tests are as follows: FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating requires pulmonary function test results as follows: FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Certain diagnostic codes require the use of post-bronchodilator studies for disability evaluation purposes, except when the results of pre-bronchodilator pulmonary function tests are normal, or when the examiner determines that post-bronchodilator studies should not be done and states why. See 38 C.F.R. § 4.96 (d); however, the diagnostic codes enumerated under that section (6600, 6603, 6604, 6825-6833, and 6840-6845) do not include Diagnostic Code 6602 (asthma). Accordingly, that section is not applicable to the claim and both pre- and post-bronchodilator results must be considered. The Veteran was provided with a VA examination in March 2014. The examiner diagnosed asthma and chronic obstructive pulmonary disease (COPD) and opined that he was not sure which was causing his problems. The Veteran reported that he used Symbicort inhaler twice per day, and Albuterol inhaler as needed. The Veteran’s respiratory condition does not require the use of oral or parenteral corticosteroid medications. The Veteran reported one asthma attack with episodes of respiratory failure per week over the prior 12 months. The Veteran had made one visit to the emergency room in February 2014; however, the examiner noted that he had the frequency of exacerbations over the prior 12 months of less than one per month. The Veteran underwent pulmonary function testing reflecting pre-bronchodilator values of 62 percent for FVC predicted, 55 percent for FEV-1 predicted, and 89 percent for FEV-1/FVC, and post-bronchodilator values of 75 percent for FVC predicted, 70 percent for FEV-1 predicted, and 94 percent for FEV-1/FVC. The examiner noted that the Veteran was diagnosed with both COPD and asthma, and that he was unable to determine which was the predominant cause of his symptoms. He opined that FVC predicted was the most accurate reflection of the Veteran’s asthma. The Veteran was provided with a VA examination in May 2016. The examiner noted that the Veteran’s disability did not require the use of corticosteroids and that the Veteran had not had any physician visits for required care of exacerbations. The Veteran had not had any asthma attacks with episodes of respiratory failure. The Veteran underwent pulmonary function testing reflecting pre-bronchodilator values of 64 percent for FVC predicted, 55 percent for FEV-1 predicted, and 86 percent for FEV-1/FVC, and post-bronchodilator values of 76 percent for FVC predicted, 63 percent for FEV-1 predicted, and 82 percent for FEV-1/FVC. The examiner found that FEV-1 predicted most accurately reflected the Veteran’s level of disability. The Veteran was provided with a VA examination in April 2019. The examiner noted that the Veteran’s disability did not require the use of corticosteroids and that the Veteran had not had any physician visits for required care of exacerbations. The Veteran had not had any asthma attacks with episodes of respiratory failure. The examiner referenced pulmonary function test results performed in May 2016. The Board finds that the evidence of record shows that the Veteran’s service-connected asthma warrants a 60 percent disability rating under Diagnostic Code 6602. The Veteran’s pre-bronchodilator values for FEV-1 were 55 percent predicted at his VA examinations, which meets the criteria for a 60 percent rating throughout the appeals period. While the Veteran meets the criteria for a 60 percent rating, the Board notes that his asthma does not cause impairment that meets or approximates the criteria for a 100 percent disability rating. The Veteran has not had pulmonary function testing results of FEV-1 less than 40-percent predicted or FEV-1/FVC less than 40 percent or more than one attack per week with episodes of respiratory failure. In addition, asthma has not required daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications at any time over the appeals period. As such, a 60 percent disability rating, but no higher, for the Veteran’s service-connected asthma is granted throughout the appeals period. Hepatitis B The Veteran’s service-connected hepatitis B is rated at a noncompensable disability rating under Diagnostic Code 7345, which provides ratings for chronic liver disease without cirrhosis (including hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis, etc., but excluding bile duct disorders and hepatitis C). 38 C.F.R. §§ 4.114, Diagnostic Code 7345. A 10 percent rating is assigned for intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. 38 C.F.R. §§ 4.114, Diagnostic Code 7345. The Veteran was provided with VA examinations in March 2014 and April 2019. The examiner noted that the Veteran did not have symptoms of hepatitis B and no incapacitating episodes. The Veteran was provided with a VA examination in May 2016. The examiner noted that the Veteran had daily fatigue and intermittent upper quadrant abdominal pain but that he was not able to palpate the liver. The Veteran did not have incapacitating episodes due to hepatitis B. The examiner noted that the Veteran’s he also has COPD and asthma that contributed to his fatigue. The Board finds that a compensable disability rating is not warranted for the Veteran’s hepatitis B at any time over the appeals period. While he reported fatigue, the examiner noted that fatigue was also due to his respiratory disabilities. In addition, the Veteran did not report fatigue at his March 2014 and April 2019 VA examinations. The Veteran did not have malaise or anorexia and, while he did report abdominal pain, he did not have incapacitating episodes as defined in the regulation. The Board therefore concludes that the Veteran’s symptoms of hepatitis B did not more nearly approximate the criteria for a compensable disability rating. The Veteran is competent to report observable symptoms, include symptoms such as pain. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran’s lay statements describing his symptoms do not provide a basis upon which to provide a compensable rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for hepatitis B. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 C.F.R. § 3.102. Hearing Loss The Veteran contends that he is entitled to a higher rating for his service-connected hearing loss. 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 pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability from bilateral service-connected hearing loss, 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. An exceptional pattern of hearing impairment occurs when the pure tone 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 that situation, 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 pure tone 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). A November 2014 VA examination reveals that the Veteran reported that he had to ask people to repeat themselves in order to understand them. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran’s Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 20 20 35 60 34 92% LEFT 20 15 30 70 34 96% A May 2016 VA examination reveals that the Veteran reported that he did not have functional loss due to his hearing loss. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran’s Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 20 25 45 70 40 96% LEFT 15 15 30 65 31 96% An April 2019 VA examination reveals that the Veteran reported that he had difficulty understanding what people said and had trouble hearing on the telephone. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran’s Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 20 20 30 65 34 96% LEFT 20 35 60 75 31 94% Applying the results to Table VI, the findings in all of these examinations yield a numeric designation of Level I in both ears. Entering this bilateral numeric designation to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. Based on the evidence above, a compensable rating for the Veteran’s bilateral hearing loss is not warranted at any time over the appeals period. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including difficulty understanding people in conversation and problems hearing on the telephone. The Veteran is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes, is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran’s main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a compensable rating for hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 C.F.R. § 3.102. Tinnitus The Veteran’s service-connected tinnitus is assigned a 10 percent rating, effective July 10, 2017, pursuant to 38 C.F.R. § 4.85, Diagnostic Code 6260. In this regard, such Diagnostic Code was revised effective June 13, 2003, to codify existing VA practice of assigning a single 10 percent rating for recurrent tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2). As the Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available pursuant to 38 C.F.R. § 4.87, Diagnostic Code 6260, and as there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear, there is no legal basis upon which to award a higher schedular rating. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Additionally, the Veteran has not reported, and the evidence does not demonstrate, manifestations of his tinnitus that are not contemplated by the currently assigned schedular rating. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Therefore, there is no doubt to be resolved and the Veteran’s claim for a rating in excess of 10 percent for tinnitus must be denied. Superficial Laceration Scar Below Right Eyebrow The Veteran contends that he is entitled to a higher rating for his superficial laceration scar below the right eyebrow. The Veteran’s superficial laceration scar below the right eyebrow is rated under Diagnostic Code 7800, for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7800 was not changed by the August 13, 2018, amendments. Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent under Diagnostic Code 7800. The Veteran was provided with a November 2014 eye examination. The examiner noted that the Veteran had a superficial healed scar beneath his right eyebrow. The examiner did not indicate that the scar had any characteristics of disfigurement. The Veteran was provided with a VA scars examination in June 2016. The scar was not bothersome, painful, or unstable. The examiner found that the scar was well healed and very difficult to see. The examiner indicated that he had to part the eyebrow hairs and look intensely for the break in the skin in the intense bright light to locate the scar. The scar was not tender and there was no edema, erythema, keloid formation, or adherence to underlying tissue. There was no hypopigmentation or hyperpigmentation of the scar. It was smooth with no loss of underlying tissue or indentation. The examiner found that there was objective medical evidence of asymmetry of the eyebrows or significant disfiguration as the scar is not easily visible. The length and width of scar was 0.2 X 0.1 centimeters. At an April 2019 examination, it was noted that the Veteran’s scar had disappeared into his eyebrow and was considered resolved. The Veteran does not have visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features, or four or five characteristics of disfigurement. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scar is not deep or non-linear and is not associated with underlying soft tissue damage. It does do not cover an area or areas of 144 square inches or greater. Moreover, the Veteran’s scar is not unstable or painful. Therefore, Diagnostic Codes 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no disabling effect associated with his service-connected right eyebrow scar. The Veteran is competent to report observable symptoms, include symptoms such as pain. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he does not assert, and medical records do not show, that the Veteran’s scar is manifest by visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features, or; four or five characteristics of disfigurement. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent for superficial laceration scar below the right eyebrow. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Eye Disorder, to Include Glaucoma The Veteran contends that he has an eye disorder that is related to service. He was provided with a VA examination in November 2014. The examiner was asked to opine as to whether the Veteran’s “current eye problems” were at least as likely as not proximately due to or the result of the noted eye complaints in the service. At that time the examiner diagnosed “glaucoma suspect based on cup/disc asymmetry” and opined that the Veteran was not currently diagnosed with glaucoma. In the examination report, the examiner also noted that the Veteran had lacrimal gland and lid disorders (other than ptosis or anatomic loss), cataract and other lens conditions, and glaucoma but did not provide an opinion as to these disorders. 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 (2007). On remand, an addendum opinion should be provided as to whether any of the Veteran’s diagnosed eye disorders are related to service. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the Veteran’s diagnosed eye disabilities. Schedule a VA examination only if necessary. The examiner must review the claims file. The examiner is asked to provide an opinion as to whether each diagnosed eye disability is at least as likely as not related to service. In so opining, the examiner must address the eye disorders diagnosed at the Veteran’s November 2014 VA examination: lacrimal gland and lid disorders (other than ptosis or anatomic loss), cataract and other lens conditions, and glaucoma. (Continued on the next page)   Provide a rationale to support the opinion(s). J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Harrigan Smith 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.