Citation Nr: 21065033 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-26 685 DATE: October 22, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, alcohol use disorder and opiod use disorder, is denied. Entitlement to service connection for sleep apnea (also claimed as sleep condition) is denied. Entitlement to service connection for headaches, to include as secondary to service-connected hypertension and tinnitus, is granted. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to a disability rating in excess of 10 percent for hypertension is denied. Entitlement to a disability rating in excess of 10 percent for tinnitus is denied. Entitlement to an effective date earlier than May 10, 2016, for the grant of service connection for hypertension is denied. Entitlement to an effective date earlier than December 29, 2013, for the grant of service connection for tinnitus is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran's acquired psychiatric disorder is related to service. 2. The preponderance of the evidence is against a finding that the Veteran's sleep apnea is related to service. 3. Resolving all doubt in favor of the Veteran, the Veteran's headache disorder is proximately due to the Veteran's service-connected tinnitus and hypertension. 4. The Veteran did not have a diagnosis for erectile dysfunction, and even if erectile dysfunction was present there is no suggestion that it is related to service or a service-connected disability. 5. The Veteran's level of hearing loss did not meet the criteria to constitute a disability for VA purposes. 6. The current 10 percent rating for tinnitus is the maximum schedular rating available. 7. The preponderance of the evidence of record does not reflect findings of diastolic pressure predominately 110 or more, or systolic pressure predominately 200 or more. 8. A claim for entitlement to service connection for hypertension was submitted by the Veteran on May 10, 2016; neither the Appellant nor her attorney have identified any communication or other action that indicates an intent to apply for VA benefits for hypertension prior to that date. 9. A claim for entitlement to service connection for tinnitus was submitted by the Veteran on December 29, 2014; neither the Appellant nor her attorney have identified any communication or other action that indicates an intent to apply for VA benefits for hypertension prior to that date. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, alcohol use disorder and opiod use disorder, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309 (2020). 2. The criteria for entitlement to service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for headaches, to include as secondary to hypertension and tinnitus, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for establishing service connection for erectile dysfunction 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 bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 6. The criteria for a disability rating in excess of 10 percent for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.104, Diagnostic Code (DC) 7101. 7. Entitlement to a disability rating in excess of 10 percent for tinnitus is without legal merit. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.87, DC 6260. 8. The criteria for an effective date earlier than May 10, 2016, for the award of service connection for hypertension are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. The criteria for an effective date earlier than December 29, 2013 for the award of service connection for tinnitus are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1979 to June 1984 and January 1986 to June 2001. He died in July 2018. The Appellant is his surviving spouse and has been substituted as the claimant for purposes of this appeal. These matters come before the Board of Veterans' Appeals (Board) on appeal from March 2015 and July 2016 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The matters of entitlement to an increased rating and earlier effective date for hypertension, and entitlement to service connection for hearing loss were previously before the Board in October 2018 and were remanded upon notification of the Veteran's death to adjudicate a request for substitution of the claimant. In an October 2018 Administrative decision, the Veteran's spouse was substituted for the claimant. The matters are once again before the Board. Duty to assist The record indicates the Veteran received private treatment for his mental health condition but these records are not associated with the claims file. The Veteran and the Appellant had the opportunity to authorized VA to obtain those records on their behalf or submit them in support of the claim. In March 2016 and September 2020, the Veteran and the Appellant, respectively, were asked to identify and submit directly, or authorize the VA to obtain private treatment records on their behalf by submitting a VA form 21-4142, Authorization for release of information. See March 2016 Decision Review process explanation letter and September 2020 Subsequent development letter. The records were not submitted directly nor was authorization to obtain them submitted to the VA. The duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). VA is only obligated to obtain records that are adequately identified and for which necessary releases have been submitted. 38 C.F.R. § 3.159(c)(1). Therefore, as the Veteran nor the Appellant did not authorize the release of any additional outstanding treatment records, the Board will proceed with adjudicating the claim on appeal based on the available evidence of record. Additionally, the record indicates that the Veteran received Social Security Disability for a shoulder injury. Although the claims file does not contain the Veteran's Social Security Administration (SSA) disability records, the Board finds no duty to assist error has been committed as there is no indication that these SSA records are relevant to the issues on appeal. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010) (holding the VA's duty to assist obligates it to obtain relevant records, and that SSA records pertaining to "a completely unrelated medical condition" are not relevant unless relevance is explained by the veteran). Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Mental health condition The Appellant contends that the Veteran's mental condition was related to his service. Service treatment records demonstrate the Veteran sought family and marital counseling in April 1990. In October 1990, the Veteran was noted as having an adjustment disorder related to marital problems with moderate to severe associated physical conditions (no specific conditions were listed). In November and December 1990 follow-up visits, mental status examinations reported the Veteran was within normal limits and the assessment was unchanged. In July 1994, the Veteran reported mild anxiety with shortness of breath and heart palpitations. The treatment record noted that he consumed 4 cups of coffee in the morning. He was advised to reduce his caffeine consumption and follow up in a week if the problem persisted. The record does not demonstrate that the Veteran followed up. On the Veteran's April 2001 retirement report of medical assessment, the Veteran did not report any mental or psychological disorders. Post-service treatment records report the Veteran attributed his psychiatric conditions to a romantic break-up in which he became "very depressed" and his addiction to drugs and alcohol became pronounced. He reported that his depression and anxiety started when he found out his fiancé was unfaithful. He also stated that he was introduced to methamphetamines by his second wife around that time. See September 2016 treatment records. At a November 2016 psychological evaluation, the physician found the Veteran's "past mental health problems appeared to be directly related to breakup of a romantic relationship and not related to his military service." See November 2016 treatment records. In August 2017, in furtherance of his claim, the Veteran was provided a VA examination. The examiner diagnosed the Veteran with a depressive disorder, anxiety disorder, alcohol use disorder and opiod use disorder. The examiner noted the Veteran's report of anxiety with shortness of breath and heart palpitations in-service but found no follow-up treatment. The examiner reviewed the Veteran's reported history, and found the Veteran to be an inaccurate historian, noting the inconsistencies between the Veteran's self-report and the medical record. The examiner reported the Veteran's anxiety was triggered by layoffs following the September 11, 2001 terrorist attacks. The examiner concluded the Veteran's condition was less likely than not related to service, finding no evidence of a persistent disability in service. In May 2020, the Appellants attorney submitted an August 2016 private examination report and opinion, from Dr. S.H-G., related to the Veteran's psychiatric conditions. Dr. S.H-G. reported a diagnosis of major depressive disorder and alcohol use disorder. Dr. S.H-G. described the Veteran's symptomology and concluded that it was more likely than not that these conditions began in service and continued uninterrupted to the present. The Board affords the report from Dr. S.H-G low probative value. First, Dr. S.H-G.'s report states that the disability began while on active duty but does not address the April 2001 self-assessment wherein the Veteran did not identify psychiatric issues. It does not address the Veteran's report of anxiety starting after losing his job following the September 2001 attacks. The opinion does not address the Veteran's statements that his psychiatric illness began following relationship troubles in 2001. The opinion cites to multiple medical articles that address the emergence of mental health symptoms within active duty servicemembers, but the report does not explain how these reports apply to the facts in this case. The report notes that "traumatic events are common for patients with substance abuse and are often associated with the development of" psychiatric illnesses, but the opinion does not identify a traumatic event experienced by the Veteran. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). Because the report does not contain a "reasoned medical explanation," the Board affords it lesser probative value. The Board has considered the Veteran and Appellant's statements that his psychiatric disorder is related to service and notes that they are both competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Although they are competent to report the existence of depression and anxiety, they are not competent to diagnose a psychiatric disability, opine on whether such a disability started in service, or determine whether it is related to an in-service injury or disease. The Board must determine on a case-by-case basis whether a particular medical issue is within the competence of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Veteran and the Appellant in this case are not shown to possess any pertinent medical training or expertise that would make them competent to render an opinion as to its etiology or an opinion as to when the disability onset. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Making the latter determination requires training on the etiology and progression of psychiatric disorders. Thus, to the extent that the Veteran and Appellant's lay statements express an opinion that a psychiatric disability developed during service or is related to active duty service, they are not competent medical opinions and cannot be assigned any probative weight. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the August 2017 VA opinion rendered by a trained medical professional with reasonably drawn conclusions with supportive rationale. To the extent the Veteran contended that he developed a psychiatric disability during service which continued until his death, the Board finds such statements not credible. As discussed above, service treatment records document that the Veteran was undergoing relationship counseling in 1990 while on active duty, but his symptoms resolved. A March 1992 examination found no psychiatric abnormalities. He denied psychiatric symptoms in a June 1996 self-report of medical history. Moreover, the Veteran did not identify any psychiatric symptoms or concerns in an April 2001 medical assessment, despite noting the presence of other issues. If the Veteran had been experiencing ongoing psychiatric symptoms, it is reasonable to assume he would have noted such symptoms when addressing the existence of other issues. In short, although an in-service disease is demonstrated, the record indicates that it resolved prior to his discharge. The Board recognizes that the Veteran has reported the onset of psychiatric symptoms in 2001, and while he did not identify such symptoms in the above-mentioned April 2001 medical assessment, he did not separate from service until June 2001. These facts, along with the Veteran's report of psychotic symptoms developing prior to his discharge, were also before the August 2017 VA examiner. Following a clinical interview and a review of the record, the examiner found that the Veteran was not a reliable historian and that the Veteran's psychiatric disability was not incurred in service. Instead, it was noted that the disability onset after service and the report notes that the Veteran's anxiety was "triggered" after being laid off from the airline industry following the September 2001 attacks. The Board finds this to be highly probative evidence as the examiner was able to interview the Veteran and conduct a clinical examination. The report was not based on the absence of documentation in the service treatment records but took into account the Veteran's lay statements and medical history. C.f. Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37 (Fed. Cir. 2006). Prior to October 2010, the Veteran did not receive treatment through the VA. Instead, the record indicates that he received private medical care, to include psychiatric treatment from Drs. Green and Fox. It is possible that these records could shed additional light on the onset of the Veteran's psychiatric disability. However, as discussed above, the Veteran's private treatment records have not been associated with the claims file and VA has not been authorized to obtain these records. Based on the forgoing the Board finds that service connection for an acquired psychiatric disorder, to include depression, anxiety, alcohol use disorder and opiod use, is not warranted. Because the preponderance of the evidence is against finding that the mental disorders started in service or are related to service, the claim must be denied. Sleep Apnea The Veteran was diagnosed with sleep apnea in September 2015. The Veteran's service treatment records do not demonstrate any diagnosis or treatment for sleep apnea or sleep related issues. The Veteran specifically denied sleep trouble during service. See November 1985 and June 1991 examination reports. He denied trouble sleeping and being awakened with trouble catching his breath in June 1997. Additionally, there is no evidence of an ongoing sleep disorder on the Veteran's April 2001 retirement report of medical assessment. Post-service treatment records demonstrate the Veteran underwent a sleep study in September 2015. He reported a history of insomnia beginning in the 1990s but had never undergone a sleep study. It was noted that he was on medication for "sleep and anxiety" but stopped taking these medications a year ago. Following the study, the Veteran was diagnosed with sleep apnea and provided a CPAP machine. The Board has considered the Veteran's report of sleep issues beginning in the 1990s but finds the contemporaneous evidence of record to be more probative than statements made during the September 2015 sleep study. As discussed above, medical professionals have noted that the Veteran was an inaccurate historian, and his service treatment records do not document any sleep related issues despite noting the presence of other symptoms and complaints. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than subsequently reported history). Given the above, the Board finds the preponderance of the evidence does not establish an in-service incurrence. In the absence of an in-service disease or injury, it necessary follows that a nexus is lacking. Indeed, the evidence of record does not include a competent statement relating the Veteran's post-service sleep apnea to his active duty service. The Board acknowledges that a medical opinion has not been obtained to determine the etiology of his disability. However, only the suggestion of an association between the Veteran's sleep problems and service comes from his assertion of sleep problems beginning in the 1990s. As discussed above, the Board has found that such statements are not credible. These statements do not rise to the level of the 'indication of an association' referred to in 38 U.S.C. § 5103A or in McLendon v. Nicholson, 20 Vet. App. 79 (2006). Although lay statements may be sufficient to establish an indication that the disability or symptoms may be related to service, there are some instances in which the lay evidence falls short of satisfying this standard. See Colantonio v. Shinseki, 606 F.3d 1378. In this case, the Board finds that the Veteran's statements linking his disability to service do not satisfy the 'indication of an association' element. These statements are entitled to no probative value because they are not credible. The Appellant's attorney has argued that sleep apnea should be granted as secondary to depression and submitted a May 2020 private opinion from Dr. H.S. linking the two disabilities. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) evidence that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. While the private opinion attributes the Veteran's sleep apnea to his depression, the Veteran is not service connected for depression. Therefore, service connection as secondary to depression must fail as a matter of law. 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994). Headaches The Appellant asserted that the Veteran's headaches were related to service. The Veteran's service treatment records do not demonstrate any diagnosis or treatment for headaches. Additionally, there is no evidence of an ongoing headache disorder on the Veteran's April 2001 retirement report of medical assessment. In July 2017, a VA examiner found the Veteran's headaches less likely than not related to his service. The examiner reasoned that there was no evidence of a headache disorder in service to reconcile the Veteran's current headache disability. No other rationale was provided. In May 2020, the Appellant's attorney submitted a private headache examination from February 2017. The Veteran's private physician, Dr. H.S., found that the Veteran's headaches are more likely than not caused and aggravated by the Veteran's service-connected tinnitus and hypertension. The physician reasoned the Veteran's symptomology was consistent with tension headaches associated with hypertension and tinnitus. The physician also cited to several medical journal articles in support of his position. There are no other opinions addressing whether the Veteran's headache disorder is secondary to his service-connected disabilities. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a headache disorder, as due to service-connected hypertension and tinnitus, is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310. Erectile dysfunction The Veteran asserted his erectile dysfunction was related to service. See December 2014 VA 21-526EZ claim form. The Veteran's service treatment records do not demonstrate any complaints, diagnosis, or treatment for erectile dysfunction. The Veteran did not identify erectile dysfunction in the April 2001 self-assessment and there is no evidence establishing that erectile dysfunction had its onset in service. In the absence of an in-service disease or injury, the claim fails on this basis alone. Post-service treatment records also do not demonstrate a diagnosis, treatment, or medication for erectile dysfunction. Instead, outpatient treatment records document the Veteran's complaints of a low libido since starting a new psychiatric medication in September 2015. He denied difficulty functioning sexually while receiving treatment in April 2016. Erectile dysfunction is capable of lay observation; thus, the Veteran was competent to report erectile dysfunction. See 38 C.F.R. § 3.159(a)(2). However, the Veteran did not provide any information on the nature or etiology of this issue. Instead, he simply wrote "erectile dysfunction" on a claims form. In contrast, the Veteran reported to medical professionals that he did not have any difficulty functioning sexually in 2016. The Board finds his statements made in April 2016 denying any sexual dysfunction to be more credible and probative than statements made to VA for purposes of seeking compensation. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). The April 2016 statement was made in the course of procuring medical services. Where the declarant knows that a false statement may cause misdiagnosis or mistreatment, the statement carries special guarantees of credibility. White v. Illinois, 502 U.S. 346, 356, 112 S.Ct. 736 (1992). Thus, the Veteran's contradicting statement that he had erectile dysfunction is not credible. The Board has considered expanding the Veteran's claim to include a diminished sex drive but finds that this is not a disability as there is no evidence that the diminished libido resulted in a functional impairment of the Veteran's earning capacity. The Board is aware that M21-1,V.iii.7.3.b instructs AOJ adjudicators to grant special monthly compensation for the loss of a creative organ when the evidence shows that there is a "loss of libido" or the "loss of sexual drive. However, in this case, the Veteran's sexual drive was described by medical professionals as "diminished," not absent. Regardless, even if the Board were to find that this was a disability, the claim would still fail based on the absence of an in-service injury or disease. The Board has also considered whether service connection could be awarded on a secondary basis as the Veteran attributed his low libido to a change in medication. However, the change was from Paxil to Venlafaxine, both drugs are used to treat psychiatric symptoms and service connection has not been established for a psychiatric disability. Thus, a secondary service connection theory would not succeed. The preponderance of the evidence does not establish an in-service incurrence and there is no evidence, including lay statements, which suggests any erectile dysfunction is related to service or a service-connected disability. Although the Veteran reported a decreased sex drive after changing psychiatric medications, service connection has not been awarded for an acquired psychiatric disability. Necessarily, the nexus element cannot be met. Furthermore, in the absence of a current medical diagnosis of erectile dysfunction, service connection cannot be granted. Thus, the Board finds that the preponderance of the evidence is against the claim, and entitlement to service connection for erectile dysfunction must be denied. Hearing loss Impaired hearing is considered a disability for VA purposes when: the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran was provided a VA audiological examination in March 2015. The pure tone thresholds at that time, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 20 15 20 25 LEFT 15 20 15 20 15 Speech audiometry revealed speech recognition ability of 98 percent in the right ear and 96 percent in the left ear. As noted above, 38 C.F.R. § 3.385 requires that the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz, in ISO units, is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores are less than 94 percent. The medical evidence of record fails to demonstrate any auditory threshold of 40 dB or greater and does not reflect three or more auditory thresholds of 26 dB or greater. CNC speech recognition was not less than 94 percent. To the extent that the Veteran contends that he has impaired hearing, this is demonstrated in the examination report. However, the question to be resolved is whether such hearing loss constitutes a disability for VA purposes under 38 C.F.R. § 3.385. Neither the Appellant nor Veteran submitted any evidence establishing that the Veteran had a hearing loss disability for VA compensation purposes. In June 2016, the Veteran was scheduled for an examination, but did not report to the examination or show good cause for missing the appointment. He was accorded ample opportunity to present evidence in support of his claim, and he failed to do so. See 38 U.S.C. § 5107(a) (it is the claimant's responsibility to support a claim for VA benefits). In the absence of a current disability, service connection may not be granted. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection cannot be granted if the claimed disability does not exist). Based on the forgoing, the Board finds that entitlement to service connection for bilateral hearing loss is denied, as the Veteran did not meet the threshold requirements for hearing loss for VA purposes under 38 C.F.R. § 3.385. Increased rating Generally, disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. Hypertension The Veteran's service-connected hypertension is currently provided a 10 percent disability rating under DC 7101 for hypertensive vascular disease. Under DC 7101, hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires the continuous use of medication for control, is rated 10 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more, is rated 20 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 120 or more is rated 40 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 130 or more is rated 60 percent disabling. 38 C.F.R. § 4.104, DC 7101. The Veteran's hypertension was rated as 10 percent disabling. To be entitled to a higher rating, at a minimum, the evidence will have to establish hypertensive vascular disease with diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. The Veteran was scheduled for VA examinations in June 2016 and December 2017, however, he failed to report for either examination. VA outpatient treatment records contain multiple blood pressure readings, such as: 187/116 (March 2015), 130/82 and 109/58 (April 2015), 177/94 (April 2015), 166/106 (April 2016), 121/82 (April 2016), and 170/96 (January 2018). The records also reflect the Veteran was prescribed medication to control his blood pressure. After reviewing the Veteran's medical records, the Board finds that the preponderance of the evidence of record does not reflect diastolic pressure predominately 110 or more, or systolic pressure predominately 200 or more. Although a diastolic blood pressure reading of 116 was recorded in March 2015, the above evidence reflects that the Veteran's blood pressure readings have never "predominantly" shown diastolic pressure at 110 or more or systolic pressure at 200 or more. Accordingly, the claim for an increased rating is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). Tinnitus The Appellant seeks a disability rating in excess of 10 percent for the Veteran's service-connected tinnitus. Historically, the Veteran was granted service connection for tinnitus in a February 2010 rating decision, effective August 18, 2009. In March 2018, the Veteran filed a claim for tinnitus. The Agency of Original Jurisdiction (AOJ) treated the claim as a request for an increased rating because the Veteran was already service connected for tinnitus. In a June 2018 rating decision, the Veteran's request for an increased rating was denied and his 10 percent rating was continued. The Veteran appealed this decision on an April 2019 Notice of Disagreement (NOD). The Veteran requested an earlier effective date for the grant of tinnitus and an appeal for an increased rating was also initiated by the AOJ. Tinnitus is evaluated under Diagnostic Code 6260, which was revised effective June 13, 2003, to clarify existing VA practice that only a single 10 percent evaluation is assigned 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). In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the Federal Circuit concluded that the Court erred in not deferring to the VA's interpretation of its own regulations, 38 C.F.R. § 4.25 and Diagnostic Code 6260, which limits a veteran to a single 10 percent maximum rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. In this case, the Veteran's service-connected bilateral tinnitus has been assigned the maximum schedular rating available for the period on appeal under 38 C.F.R. § 4.87, Diagnostic Code 6260. As there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear, the Veteran's appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Based on the foregoing, entitlement to an evaluation in excess of 10 percent for service-connected tinnitus must be denied. Effective Date Generally, the effective date of the grant of service connection is based on either the date the original claim was received; the date the petition to reopen the claim was received after a final disallowance; or the date the entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. There is a limited exception for claims received on or between August 6, 2013 and August 5, 2015 and filed as a Fully Developed Claim. In such cases, the effective date assigned may be one year before the date the application was received, but no earlier. However, the effective date shall be fixed in accordance with the facts found. 38 U.S.C. § 5110(b)(2)(A). Hypertension The Veteran filed a claim for disabilities other than hypertension in December 2014. While processing these claims, a deferred rating decision was issued which noted that the Veteran's service treatment records show a diagnosis for hypertension and his VA treatment records show elevated blood pressure readings. The deferred decision states that the Veteran should be invited to file a claim for hypertension. This was accomplished in a March 24, 2015 notification letter which advised the Veteran to submit his claim as soon as possible to ensure the earliest possible payment date if service-connection was warranted. A formal claim seeking service connection for hypertension was filed in May 2016. In a July 2016 rating decision, entitlement to service connection was granted effective May 13, 2016. This date was subsequently changed to May 10, 2016. Amendments to VA's regulations, effective March 24, 2015, describe the specific and limited manner and methods by which a claim can be initiated and filed. See 38 C.F.R. §§ 3.1(p), 3.150, 3.155, 3.160 (2015). The prior version of 38 C.F.R. § 3.155 provided that an informal claim is "[a]ny communication or action, indicating an intention to apply for one or more benefits.... Such informal claim must identify the benefit sought." 38 C.F.R. § 3.155(a). Thus, the essential elements for any claim, whether formal or informal, are "(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing." Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). Here, there is no communication of record which can be construed as an earlier claim for entitlement to service connection for this disability. Neither the Appellant nor her attorney has asserted any basis on which an earlier effective date should be awarded. See Shea v. Wilkie, 926 F.3d 1362, 1370 (Fed. Cir. 2019) ("language that points to records mentioning... a condition in a way that, sympathetically read, is properly understood as seeking benefits for such a condition" can satisfy the "identify the benefit sought" requirement of 38 C.F.R. § 3.155(a)). In short, there is no document prior May 2016 from which it could be inferred that the Veteran was seeking benefits for hypertension. Accordingly, the earliest possible effective date for the Veteran's claim of service connection for hypertension is May 10, 2016, the date he first submitted his claim. 38 U.S.C. § 5110. Thus, an effective date earlier than May 10, 2016, for the grant of service connection for hypertension is denied. Tinnitus The Veteran filed a formal claim for service connection for tinnitus on December 29, 2014. In a March 2015 rating decision, entitlement to service connection was granted at 10 percent effective December 29, 2013. The AOJ assigned the effective date one year prior to the date of claim based on the limited exception related to fully developed claims received on or between August 6, 2013 and August 5, 2015. 38 U.S.C. § 5110(b)(2)(A). (Continued on the next page) There is no communication of record which can be construed as an earlier claim for entitlement to service connection for this disability. Neither the Appellant nor her representative has asserted any basis on which an earlier effective date should be awarded. Accordingly, the earliest possible effective date for the Veteran's claim of service connection for tinnitus is December 29, 2013, one year prior to the date the Veteran first submitted his fully developed claim. Thus, an effective date earlier than December 29, 2013, for the grant of service connection for tinnitus is denied. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.V. Palatt, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.