Citation Nr: 21071689 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-50 084A DATE: December 1, 2021 ORDER The application to reopen the claim of service connection for nasopharyngeal carcinoma is granted. The application to reopen the claim of service connection for left ear hearing loss is granted. Entitlement to service connection for lung cancer is granted. Entitlement to service connection for nasopharyngeal carcinoma is granted. Entitlement to service connection for hypothyroidism is denied. Entitlement to service connection for left ear hearing loss is denied. Entitlement to service connection for rhinitis is denied. Entitlement to service connection for sinusitis is denied. Entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for back disability is denied. Entitlement to service connection for neck disability is denied. Entitlement to service connection for right knee disability is denied. Entitlement to service connection for left knee disability is denied. Entitlement to service connection for sleep apnea with snoring and fatigue is denied. Entitlement to service connection for left shoulder and arm disability is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for dizzy spells is denied. Entitlement to service connection for frequent otitis media and ear infections is denied. Entitlement to service connection for high cholesterol is denied. Entitlement to service connection for sinus bradycardia is denied. Entitlement to service connection for esophageal constriction is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for frequent leg cramps is denied. Entitlement to service connection for arthritis is denied. Entitlement to service connection for lumps and cysts on entire body is denied. Entitlement to service connection for acquired psychiatric disorder, to include depression, is denied. Entitlement to a compensable initial disability rating for right ear hearing loss is denied. Entitlement to an initial disability rating higher than 10 percent for tinnitus is denied. Entitlement to an effective date prior to September 30, 2014 for the grant of the claim of service connection for right ear hearing loss is denied. Entitlement to an effective date prior to September 30, 2014 for the grant of the claim of service connection for tinnitus is denied. FINDINGS OF FACT 1. In a July 2003 rating decision, the Agency of Original Jurisdiction (AOJ) denied the Veteran's claims of service connection for nasopharyngeal cancer and left ear hearing loss. Although the Veteran was notified of the AOJ's decision and his appellate rights in a July 2003 letter, he did not perfect an appeal within the applicable time period in regard to those claims, nor was new and material evidence received within one year of issuance of that decision. 2. The evidence received since the July 2003 rating decision includes evidence that relates to unestablished facts necessary to substantiate the claims, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claims of service connection for nasopharyngeal cancer and left ear hearing loss. 3. The Veteran's lung cancer is related to his active duty service. 4. The Veteran's nasopharyngeal carcinoma is related to his active duty service. 5. The preponderance of the evidence of record does not reflect that the Veteran's hypothyroidism had its onset in service or is otherwise related to service. 6. The preponderance of the evidence of record does not reflect that the Veteran's left ear hearing loss had its onset in service, is otherwise related to service, or manifested within a year of separation from service. 7. The evidence of record indicates that the Veteran has not had rhinitis or related symptoms causing impairment in earning capacity during the pendency of his claim. 8. The evidence of record indicates that the Veteran has not had sinusitis or related symptoms causing impairment in earning capacity during the pendency of his claim. 9. The evidence of record indicates that the Veteran has not had hemorrhoids or related symptoms causing impairment in earning capacity during the pendency of his claim. 10. The evidence of record indicates that the Veteran has not had back disability or related symptoms causing impairment in earning capacity during the pendency of his claim. 11. The evidence of record indicates that the Veteran has not had neck disability or related symptoms causing impairment in earning capacity during the pendency of his claim. 12. The evidence of record indicates that the Veteran has not had right knee disability or related symptoms causing impairment in earning capacity during the pendency of his claim. 13. The evidence of record indicates that the Veteran has not had left knee disability or related symptoms causing impairment in earning capacity during the pendency of his claim. 14. The evidence of record indicates that the Veteran has not had sleep apnea with snoring and fatigue or related symptoms causing impairment in earning capacity during the pendency of his claim. 15. The evidence of record indicates that the Veteran has not had left shoulder and arm disability or related symptoms causing impairment in earning capacity during the pendency of his claim. 16. The evidence of record indicates that the Veteran has not had headaches or related symptoms causing impairment in earning capacity during the pendency of his claim. 17. The evidence of record indicates that the Veteran has not had dizzy spells or related symptoms causing impairment in earning capacity during the pendency of his claim. 18. The evidence of record indicates that the Veteran has not had frequent otitis media and ear infections or related symptoms causing impairment in earning capacity during the pendency of his claim. 19. The evidence of record indicates that the Veteran has not had high cholesterol or related symptoms causing impairment in earning capacity during the pendency of his claim. 20. The evidence of record indicates that the Veteran has not had sinus bradycardia or related symptoms causing impairment in earning capacity during the pendency of his claim. 21. The evidence of record indicates that the Veteran has not had esophageal constriction or related symptoms causing impairment in earning capacity during the pendency of his claim. 22. The evidence of record indicates that the Veteran has not had erectile dysfunction or related symptoms causing impairment in earning capacity during the pendency of his claim. 23. The evidence of record indicates that the Veteran has not had frequent leg cramps or related symptoms causing impairment in earning capacity during the pendency of his claim. 24. The evidence of record indicates that the Veteran has not had arthritis or related symptoms causing impairment in earning capacity during the pendency of his claim. 25. The evidence of record indicates that the Veteran has not had lumps and cysts on his entire body or related symptoms causing impairment in earning capacity during the pendency of his claim. 26. The evidence of record indicates that the Veteran has not had acquired psychiatric disorder, to include depression, or related symptoms causing impairment in earning capacity during the pendency of his claim. 27. Audiological testing shows that the Veteran has had no more than Level IV hearing loss in the right ear during the appeal period. 28. The Veteran's service-connected tinnitus is assigned the maximum disability rating authorized under Diagnostic Code (DC) 6260, and there is no evidence or argument in support of a higher or separate rating. 29. In a July 2003 rating decision, the AOJ denied the claims of service connection for right ear hearing loss and tinnitus. The Veteran was notified of this decision in July 2003, did not appeal that decision within one year of its issuance, and new and material evidence was not received within one year of that decision. Thus, the July 2003 rating decision became final. 30. On September 30, 2014, the Veteran submitted a Fully Developed Claim (VA Form 21-526EZ) for right ear hearing loss and tinnitus. There is no evidence of unadjudicated formal or informal claims of service connection for right ear hearing loss or tinnitus between the final July 2003 rating decision and September 30, 2014, the date of the claims. CONCLUSIONS OF LAW 1. The July 2003 rating decision denying the claims of service connection for nasopharyngeal cancer and left ear hearing loss is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.156(b), 20.1103. 2. New and material evidence has been received to warrant reopening the claims of service connection for nasopharyngeal cancer and left ear hearing loss. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for service connection for lung cancer are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for nasopharyngeal carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for hypothyroidism are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for left ear hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 7. The criteria for service connection for rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for sinusitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for hemorrhoids are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 11. The criteria for service connection for neck disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 12. The criteria for service connection for right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 13. The criteria for service connection for left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 14. The criteria for service connection for sleep apnea with snoring and fatigue are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for service connection for left shoulder and arm disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 16. The criteria for service connection for headaches are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 17. The criteria for service connection for dizzy spells are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 18. The criteria for service connection for frequent otitis media and ear infections are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 19. The criteria for service connection for high cholesterol are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 20. The criteria for service connection for sinus bradycardia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 21. The criteria for service connection for esophageal constriction are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 22. The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 23. The criteria for service connection for frequent leg cramps are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 24. The criteria for service connection for arthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 25. The criteria for service connection for lumps and cysts on entire body are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 26. The criteria for service connection for acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 27. The criteria for a compensable initial disability rating for right ear 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. 28. There is no legal basis for a schedular disability rating higher than 10 percent for the Veteran's service-connected tinnitus, remand for referral for consideration on an extraschedular basis is not warranted, and there is no evidence or argument for a higher or separate disability rating. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.87, DC 6260. 29. The criteria for an effective date earlier than September 30, 2014 for the grant of the claims of service connection for right ear hearing loss and tinnitus are not met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.1(p), 3.155, 3.156(b), 3.157 (in effect prior to March 24, 2015), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1972 to January 1993. These matters come before the Board of Veterans' Appeals (Board) on appeal from February and April 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) that denied the claims of service connection on appeal, and granted the claims of service connection for right ear hearing loss and tinnitus, with initial noncompensable and 10 percent disability ratings, respectively, both effective September 30, 2014. The Veteran died in December 2018, and the Board dismissed the claims on appeal in March 2019 for lack of jurisdiction, noting the dismissal did not affect the right of an eligible person to file a request to be substituted as the appellant for purposes of processing the claim to completion. The appellant, the Veteran's surviving widow, was substituted in February 2021 as the claimant for purposes of adjudicating the claims pending at the time of the Veteran's death. In Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009), the Court held that a claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim. In other words, the Board will broaden the Veteran's claim and consider all psychiatric diagnoses raised by the record. As a final preliminary matter, there is a separate appeal relating to the appellant's claims of Dependency and Indemnity Compensation (DIC), accrued benefits, and death pension that are not currently before the Board and are being adjudicated pursuant to the Appeals Modernization Act (AMA). These issues will be adjudicated in a separate decision by the Board. Application to reopen claims of service connection for nasopharyngeal cancer and left ear hearing loss Generally, under the legacy appeal system, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA will reopen the claim and review it on the merits. The implementing regulation also provides that new and material evidence received prior to the expiration of the appeal period will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). New evidence means evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The question of whether new and material evidence has been received is one that must be addressed by the Board, notwithstanding a decision favorable to the Veteran that may have been rendered by the RO. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001) (the Board has a jurisdictional responsibility to consider whether it was proper for the RO to reopen a previously denied claim). In a July 2003 rating decision, the AOJ denied the Veteran's claims of service connection for nasopharyngeal cancer and left ear hearing loss as there was no evidence those disabilities occurred in or were caused by service. Specifically, there were no service treatment records showing hearing loss or post-service treatment records showing hearing loss to a compensable degree within one year of discharge. There were also no service treatment records showing treatment for nasopharyngeal cancer in service, and while a letter from a private physician provided an opinion, the AOJ found there were no medical facts to directly relate the Veteran's treatment for rubella and a sore throat while in service to nasopharyngeal cancer. The Veteran was notified of the RO's decision and his appellate rights in a July 2003 letter, but he did not perfect an appeal within the applicable time period, nor was new and material evidence received within one year of issuance of those decisions. 38 C.F.R. § 20.1103. Thus, the decision became final. Evidence received since the prior final July 2003 rating decision includes a January 2015 VA audiological examination where the Veteran discussed his in-service exposure to acoustic trauma, and a February 2015 letter from a private physician relating a positive nexus opinion in regard to nasopharyngeal cancer. Given the basis for the prior denial, this evidence is new to the record, relates to previously unestablished facts to support the claims, and raises a reasonable possibility of substantiating the claims. Accordingly, reopening of the claims is warranted. Service connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to service connection for lung cancer and nasopharyngeal carcinoma The Veteran contended that his lung cancer and nasopharyngeal carcinoma were related to exposure to asbestos while performing various duties aboard naval ships. In a December 2002 letter, a private physician wrote that it was possible that the Veteran's nasopharyngeal carcinoma was directly related to the sore throat, rhinorrhea, and productive cough the Veteran developed in service in December 1972, as well as the sore throat and fever and chills he developed in December 1991. The private physician reasoned that either or both of those episodes of infection could have been precipitated by Epstein-Barr virus, the etiologic agent for infectious mononucleosis, as well as an agent which is highly associated with nasopharyngeal carcinoma. In a February 2015 letter, a private physician indicated that it was at least as likely as not that the Veteran's nasopharyngeal carcinoma was related to service. The private physician found that the Veteran's exposure to asbestos in service at an early age, genetic susceptibility, and Epstein-Barr infection were all etiologic factors of the Veteran's nasopharyngeal carcinoma diagnosis. In September 2017, a VA examiner noted that it would be mere speculation to state that the Veteran's lung cancer and nasopharyngeal carcinoma were related to service. The examiner reasoned that this was because there was no record of the Veteran's asbestos exposure or a diagnosis of asbestosis. In a June 2019 letter, a private physician found that it was at least as likely as not that the Veteran's lung cancer was related to his exposure to asbestos in service. The physician reasoned that, after review of the Veteran's occupational history, he did not have any other significant exposure to toxins, other than the asbestos exposure in service, which may have contributed in the same way to the development of his malignancy, aside from the possibility of his remote smoking history. While his smoking history was as likely as not a contributor to his cancer, it was not possible to determine the extent to which of these factors contributed to his cancer, as both are considered significant risk factors. The physician noted, however, that the Veteran had been a non-smoker for 33 years at the time of his lung cancer, which reduced the risk of death from smoking-related causes to the level an individual who has never smoked. For the following reasons, entitlement to service connection for lung cancer and nasopharyngeal carcinoma is warranted. An October 2000 private treatment record noted the Veteran's diagnosis of nasopharyngeal carcinoma. Thus, the Veteran meets the current disability requirement. There is no specific statutory guidance with regard to asbestos-related claims, nor has VA promulgated any regulations in regard to such claims. With respect to claims involving asbestos exposure, VA must determine whether the Veteran's military records demonstrate evidence of asbestos exposure during service, whether there was pre-service and/or post-service occupational or other asbestos exposure, and whether there is a relationship between asbestos exposure and the claimed disease. The Veteran's military personnel records confirm that he served as a storekeeper aboard multiple naval vessels throughout his military career. In a July 2015 statement, the Veteran reported that he spent February 1973 to December 1976 aboard the USS Sylvania, where he slept in a supply compartment under asbestos wrapped ventilation pipes, worked in storerooms under the engine rooms clearing bilges, and assisted in removing asbestos floor tiles without breathing protection. He noted that dust and flakes were all over the place when removing the tiles. Given that the Veteran's military occupational specialty was of the type with a minimal probability of exposure to asbestos, along with the Veteran's credible and competent July 2015 statement, the Veteran was likely exposed to asbestos in service. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a) (each disabling condition for which a veteran seeks service connection must be considered based on factors including the basis of places, types, and circumstances of service as shown by service records). Thus, the Veteran meets the in-service injury or disease requirement. December 2002, February 2015, June 2019 private physicians provided positive nexus opinions and found that the Veteran's lung cancer and nasopharyngeal carcinoma were related to his asbestos exposure in service. As those private physicians explained the reasons for the conclusions based on an accurate characterization of the evidence of record, those opinions are entitled to some probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). Furthermore, as the private physician found in his December 2002 letter that it was possible that the Veteran's nasopharyngeal carcinoma was directly related to the sore throat, rhinorrhea, and productive cough the Veteran developed in service in December 1972, as well as the sore throat and fever and chills he developed in December 1991, the Board will interpret the opinion in the manner most favorable to the Veteran and find that it supports a relationship between the Veteran's nasopharyngeal carcinoma and service. Cf. Brown v. Gardner, 513 U.S. 115, 118 (1994) (in construing veterans' law, "interpretive doubt is to be resolved in the Veteran's favor"). In September 2017, a VA examiner noted that it would be mere speculation to state that the Veteran's lung cancer and nasopharyngeal carcinoma were related to service as there was no record of the Veteran's asbestos exposure or a diagnosis of asbestosis. This VA opinion is of little, if any, probative value, because it relied on the absence of documentation in the evidence of record of asbestos exposure and did not consider the Veteran's lay statements regarding asbestos exposure in service. Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006) (noting that VA's examiner's opinion, which relied on the absence of contemporaneous medical evidence, failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran's] disability such that his claim for service connection could be proven without contemporaneous medical evidence). For the foregoing reasons, there is competent, probative evidence of current lung cancer and nasopharyngeal carcinoma disabilities, in-service injury, and a nexus between the two. Entitlement to service connection for lung cancer and nasopharyngeal carcinoma is therefore warranted. Entitlement to service connection for hypothyroidism and left ear hearing loss A hearing loss disability is defined for VA compensation purposes using audiologic testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. §3.385. For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Id. The Court in Hensley v. Brown, 5 Vet. App. 155, 157 (1993), indicated that 38 C.F.R. § 3.385 does not preclude service connection for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service if there is sufficient evidence to demonstrate a relationship between the Veteran's service and his current disability. The Board notes that the Court's directives in Hensley are consistent with 38 C.F.R. § 3.303(d), which provides that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Id. For the following reasons, entitlement to service connection for hypothyroidism and left ear hearing loss is not warranted. The Veteran's military occupational specialty was as a storekeeper and data systems technician. He was employed in customer service on a help desk after separation from the military. In December 2002, a private audiologist evaluated the Veteran and determined that he had left ear hearing loss for VA purposes based on the following puretone auditory threshold results: HERTZ 500 1000 2000 3000 4000 LEFT 25 35 25 75 90 The Board notes that the foregoing private audiological examination results were each recorded on a graph by Xs and Os with the Hertz and decibels on respective axes. The Board's interpretation of the testing results is such that a hearing loss disability is established by VA standards. The Board has fact-finding authority to discuss the audiological results presented on this graph and translate them into numerical format. Kelly v. Brown, 7 Vet. App. 471, 474 (1995); see also McKinney v. McDonald, 28 Vet. App. 15, 23 (2016) ("by explaining the medical basis for the naval examiner's interpretation of the audiometric test results, Hensley provided the Board" with a basis for discerning the significance of the contemporaneously recorded audiology test results). Moreover, clarification of private medical reports is required only when "a private medical report is the only evidence on a material issue, and material medical evidence can no longer be obtained as to that issue, yet clarification of a relevant, objective fact would render the private medical report competent for the assignment of weight." Carter v. Shinseki, 26 Vet. App. 534, 545 (2014), vacated on other grounds by Carter v. McDonald, 794 F.3d 1342 (Fed. Cir. 2015) (citing Savage v. Shinseki, 24 Vet. App. 259, 267-70 (2011)). As shown below, there is evidence of record other than the December 2002 private audiological examination showing the Veteran had a left era hearing loss disability for VA purposes. In January 2015, a VA audiologist evaluated the Veteran and determined that he had left ear hearing loss for VA purposes based on the following puretone auditory threshold results, as well as speech recognition results from the Maryland CNC test of 68 percent in the left ear: HERTZ 500 1000 2000 3000 4000 LEFT 20 15 35 65 75 An April 2015 VA treatment note recorded the Veteran's diagnosis of hypothyroidism. Thus, the Veteran meets the current disability requirement for both hypothyroidism and left ear hearing loss. The Veteran did not indicate that he had treatment for, symptoms of, or diagnoses of hypothyroidism or left ear hearing loss in the years between service and his diagnoses for those disabilities in December 2002 and April 2015, respectively, and he did not relay reports or diagnoses for those disabilities during those years. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (a layperson is competent to report a contemporaneous medical diagnosis). The Veteran's service treatment records from active duty do not contain any notations relating to symptoms, treatment, or diagnoses relating to hypothyroidism or left ear hearing loss. The Veteran's audiological examination at separation in December 1992 was normal, and the December 1992 Report of Medical Examination was normal in regard to hypothyroidism. The Veteran's December 1992 Report of Medical History only noted headaches and sinusitis. Post-service records reveal no mention of treatment or diagnoses for hypothyroidism and left ear hearing loss until December 2002 and April 2015, approximately nine and 22 years after separation from active duty. In this regard, evidence of a prolonged period without medical complaint, and the amount of time that elapsed since military service, is one factor, along with those above, including the lack of notations relating to symptoms, treatment, or diagnosis relating to those disabilities in the Veteran's active duty service treatment records, as well as lack of statements indicating continuity of symptoms or continuous symptoms, that can be considered as evidence against the claim. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc) (the Board may consider in its assessment of a service connection claim the passage of a lengthy period of time wherein the veteran has not complained weight of the malady at issue). In January 2015, a VA audiologist could not provide a medical opinion in regard to the etiology of the Veteran's left ear hearing loss without resorting to mere speculation as it was been too long a period of time between separation from service and the time of the examination. Thus, this examination was inadequate and is entitled to little probative weight. To the extent that the Veteran's lay statements suggest a relationship between and hypothyroidism and left ear hearing loss and service, this is the type of complex medical issue relating to an internal medical process which extends beyond an immediately observable cause-and-effect relationship as to which lay evidence is not competent. Jandreau, 492 F.3d at 1376, n.4. Moreover, the Veteran has not asserted any reasons for how his disabilities are related to service. As there is no evidence indicating that there is hypothyroidism or left ear hearing loss that may be associated with active military, naval, air, or space service, VA examinations are not warranted for these claims. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination); McLendon v. Nicholson, 20 Vet. App. 79 (2006). For the foregoing reasons, the preponderance of the evidence does not reflect that the Veteran's hypothyroidism and left ear hearing loss had their onset in service, are related to service, or manifested within a year of separation from service. The benefit of the doubt doctrine is therefore not for application, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder An undated service treatment record seems to indicate that the Veteran had sinus bradycardia. A July 1981 service treatment record noted the Veteran had a cyst or boil on his left buttocks for one week. The Veteran's February 1982 Report of Medical Examination indicated the Veteran had cramps in his legs. A May 1984 service treatment indicated that the Veteran had a mass on his right forearm for two years. Another May 1984 service treatment note reported that the Veteran had lesions on both forearms. An October 1985 service treatment record reported that the Veteran had otitis media. A September 1987 Report of Medical Examination noted that the Veteran suffered from rhinitis. A December 1992 Report of Medical History by the Veteran noted frequent or severe headaches and sinusitis. A December 1992 Report of Medical Examination at separation from service indicated the Veteran had hemorrhoids. For the following reasons, entitlement to service connection for rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder is not warranted. The preponderance of the evidence reflects that the Veteran does not have and has not had at any time during the pendency of the claim or approximate thereto, rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder, or any related disabilities or symptoms that cause impairment in earning capacity. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (finding that the Board must address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary's adjudication of the claim"); Saunders, 886 F.3d at 1364-65 (pain need not be diagnosed as connected to a current underlying condition to function as an impairment and pain alone can be considered a disability under 38 U.S.C. § 1131); Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). There is no evidence in the Veteran's service treatment records or post-service treatment records of any signs, notations, treatment for, complaints of, or diagnoses of erectile dysfunction, acquired psychiatric disorder, back disability, neck disability, bilateral knee disability, sleep apnea, left shoulder and arm disability, dizzy spells, high cholesterol, esophageal constriction, and arthritis, or related disabilities or symptoms. While there are service treatment records that note the Veteran's sinus bradycardia, cysts/lumps, leg cramps, otitis media, rhinitis, and sinusitis, the clinical evaluations at the Veteran's December 1992 separation examination were normal, except for a notation of hemorrhoids. Moreover, the conditions documented during active duty are not sufficient to establish the presence of current disabilities. The requirement of a current disability is met by evidence of symptomatology at the time of filing or at any point during the pendency of the claim. McClain, 21 Vet. App. at 323; Romanowsky, 26 Vet. App. at 293. In this case, service records only document findings of sinus bradycardia, cysts/lumps, leg cramps, otitis media, rhinitis, sinusitis, and hemorrhoids during service, and this evidence cannot serve to establish the presence of current disabilities during the applicable claim period. Post-service treatment records do not note any diagnosis, treatment for, or complaints of sinus bradycardia, cysts/lumps, leg cramps, otitis media, rhinitis, sinusitis, and hemorrhoids at any time during the pendency of the claim. Moreover, the evidence of record does not reflect rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder, or related disabilities or symptoms that cause impairment in earning capacity, or that are related to or may be associated with service. Entitlement to service connection for rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder is therefore not warranted, and VA examinations in regard to these claims are not required. Waters, 601 F.3d at 1278-79; McLendon, 20 Vet. App. at 79. As the preponderance of the evidence is against the claims of service connection for rhinitis, sinusitis, hemorrhoids, back disability, neck disability, right knee disability, left knee disability, sleep apnea with snoring and fatigue, left shoulder and arm disability, headaches, dizzy spells, frequent otitis media and ear infections, high cholesterol, sinus bradycardia, esophageal constriction, erectile dysfunction, frequent leg cramps, arthritis, lumps and cysts on entire body, and acquired psychiatric disorder, the benefit of the doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to a higher initial disability rating for right ear hearing loss Impairment of auditory acuity (hearing loss) is evaluated pursuant to the provisions set forth at 38 C.F.R. § 4.85. Under that regulation, an examination for hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations are to be conducted without the use of hearing aids. 38 C.F.R. § 4.85(a). To evaluate the degree of disability from defective hearing, the Rating Schedule establishes 11 auditory acuity levels from Level I for essentially normal acuity through Level XI for profound deafness. These are assigned based on a combination of the percent of speech discrimination and the puretone threshold average, as contained in a series of tables within the regulations. 38 C.F.R. § 4.85(b). The "puretone threshold average" is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. This average is used in all cases to determine the Roman numeral designation for hearing impairment from Table VI or VIa. 38 C.F.R. § 4.85(d). Table VIa, "Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average," is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average. Table VIa will be used when the examiner certifies that the use of speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of section 4.86. 38 C.F.R. § 4.85(c). Table VII, "Percentage Evaluations for Hearing Impairment," is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poorer hearing. The percentage evaluation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(e). The regulatory provisions also provide two additional circumstances under which alternative tables can be employed. One is where the puretone thresholds of each of the four specified frequencies of 1000, 2000, 3000, and 4000 Hertz are 55 decibels or greater. The second is where puretone thresholds are 30 decibels or less at frequencies of 1000 Hertz and below and are 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. Table VII is subject to 38 C.F.R. § 3.383, which pertains to special consideration for paired organs. Compensation is payable for certain combinations of service-connected and non-service-connected disabilities as if both disabilities were service-connected, provided the non-service-connected disability is not the result of the Veteran's own willful misconduct. The provision applies when hearing impairment in one ear is compensable to a degree of 10 percent or more as a result of service-connected disability and hearing impairment as a result of non-service-connected disability meets the provisions of § 3.385 in the other ear. 38 C.F.R. § 3.383(a)(3). This section does not apply in this case. If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. 38 C.F.R. § 4.85(f). For the following reasons, a compensable initial disability rating for right ear hearing loss throughout the appeal period is not warranted. The Veteran underwent a VA audiological examination in January 2015. Puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 20 35 80 95 The average puretone thresholds were 57.5 decibels in the right ear, while speech discrimination testing using the Maryland CNC word list was 80 percent in the right ear. These examination results indicated Level IV hearing loss in the right ear. Under Tables VI and VII in the Rating Schedule, the criteria for a compensable initial disability rating are not met with respect to these audiometric findings. 38 C.F.R. § 4.85, DC 6100. The Board has also considered the provisions of 38 C.F.R. § 4.86, but the results of the audiometric examinations show that the alternative table is not applicable. In Martinak v. Nicholson, 21 Vet. App. 447 (2007), the Court addressed a challenge to VA's audiological testing practices. Specifically, the Court discussed whether VA's policy of conducting all audiometry testing of hearing loss claimants in a sound-controlled room was valid and upheld VA's policy of conducting audiometry testing in a sound-controlled room. The Court also held that, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Here, the Veteran reported during the January 2015 VA audiological examination that he experienced difficulty hearing colleagues at work. Therefore, the report complied with Martinak. For the foregoing reasons, a compensable initial disability rating for right ear hearing loss throughout the entire appeal period is not warranted. As the preponderance of the evidence is against a higher initial disability rating for right ear hearing loss for the entire appeal period, the benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Entitlement to a higher initial disability rating for tinnitus The Veteran is in receipt of service connection for tinnitus that is evaluated at 10 percent under DC 6260. Tinnitus is evaluated under DC 6260, which was revised effective June 13, 2003, to clarify existing VA practice that only a single 10 percent evaluation is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, DC 6260, note 2. This is the maximum schedular evaluation assignable for that condition. The Federal Circuit affirmed VA's long-standing interpretation of DC 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Therefore, the Veteran's claim for greater than a 10 percent schedular disability rating for his service-connected tinnitus must be denied. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). As to consideration of referral for an extraschedular rating or entitlement to a separate or higher disability rating, the Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the rating criteria, or that he is entitled to a separate or higher disability rating. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Therefore, remand for referral for extraschedular consideration or consideration of a separate or higher disability rating is not warranted. The Board has considered the Veteran's claims and decided entitlement based on the evidence. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. Doucette, 28 Vet. App. at 369-70 (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). Entitlement to earlier effective dates for the grants of the claims of service connection for right ear hearing loss and tinnitus The Veteran has not offered a specific contention to why he is entitled to an earlier effective date for the grant of the claims of service connection for right ear hearing loss and tinnitus. While the Veteran filed previous claims of service connection for right ear hearing loss and tinnitus in August 2002, those claims were denied in a July 2003 rating decision. The Veteran was notified of that decision in July 2003, did not appeal the July 2003 decision within one year of its issuance, and new and material evidence was not received within a year of that decision. Therefore, the July 2003 decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.156(a)-(b), 20.1103; Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). On September 30, 2014, the Veteran submitted a Fully Developed Claim (VA Form 21-526EZ) for right ear hearing loss and tinnitus. In February 2015, the AOJ granted entitlement to service connection for right ear hearing loss and tinnitus, effective September 30, 2014, the date of the Fully Developed Claim. Generally, the effective date for a grant of service connection on an original claim is the day following the date of separation from active service or the date entitlement arose, if the claim is received within one year after separation from active service; otherwise date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2)(i). Effective March 24, 2015, VA amended its regulations to require that in order to be considered a valid claim, a claim for benefits must be submitted on a standardized form. 38 C.F.R. §§ 3.150, 3.151. Prior to March 24, 2015, a "claim" was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-35 (1998). Any communication indicating intent to apply for a benefit under the laws administered by the VA was considered an informal claim provided it identified, but not necessarily with specificity, the benefit sought. 38 C.F.R. § 3.155(a). To determine when a claim was received under the relevant regulations prior to their recent amendment, the Board must review all communications that may be construed as an application or claim. Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Any communication or action that demonstrates an intent to apply for an identified benefit may be considered an informal claim. 38 C.F.R. § 3.155(a). Thus, the essential elements of a claim prior to March 24, 2015, 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). Moreover, the Federal Circuit recently reversed the Court and held in Sellers v. Wilkie, 965 F.3d 1328 (Fed. Cir. 2020) that a claim must identify the sickness, disease, or injury for which compensation is sought, with at least at a high level of generality, before VA's duty to assist in the development of the claim is triggered. For the following reasons, assignment of earlier effective dates for the grants of the claims of service connection for right ear hearing loss and tinnitus is not warranted. For purposes of assigning effective dates for service connection for right ear hearing loss and tinnitus, the Board cannot look back prior to the earlier August 2002 claim, but must look to the earliest claims of service connection for right ear hearing loss and tinnitus filed subsequent to the July 2003 previous final denial and prior to September 30, 2014, the date of the Fully Developed Claim. In this regard, there is no evidence of any unadjudicated formal application to reopen the claims of service connection for right ear hearing loss and tinnitus between the final July 2003 rating decision and September 30, 2014, nor is there any prior communication in the record that could be considered an informal claim for VA compensation for the same. Administrative documents are the only documents contained in the claims file during this time period. Moreover, there is no evidence of record mentioning right ear hearing loss and tinnitus in a way that, sympathetically read, could satisfy the "identify the benefit sought requirement." Sellers, 965 F.3d 1328 (a claim must identify the sickness, disease, or injury for which compensation is sought, with at least at a high level of generality, before VA's duty to assist in the development of the claim is triggered); 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)). As previously noted, administrative documents are the only documents contained in the claims file between the final July 2003 rating decision and September 30, 2014. Finally, the Board notes that 38 C.F.R. § 3.157(b)(1), in effect prior to March 24, 2015, provides that the date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim, "[o]nce a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree." This regulation "makes clear that a medical examination report will only be considered an informal claim for an increase in disability benefits if service connection has already been established for the disability. MacPhee v. Nicholson, 459 F.3d 1323, 1327 (Fed. Cir. 2006); Massie v. Shinseki, 25 Vet. App. 123, 134 (2011), aff'd 724 F.3d 1325 (Fed. Cir. 2013) (§ 3.157(b)(1) requires that a report of examination or hospitalization indicate that the Veteran's service-connected disability worsened since the time it was last evaluated because, "[w]ithout such a requirement, every medical record generated by the Veterans Health Administration and received by VA that could possibly be construed as a report of examination would trigger the provisions of § 3.157(b)(1)," creating an unnecessary and unwarranted adjudicative burden on VA). In this case, 38 C.F.R. § 3.157(b)(1) does not apply as there was no prior allowance or disallowance of a formal claim based on the disability not being compensable in degree. For the foregoing reasons, the preponderance of the evidence is against the claims for an effective date earlier than September 30, 2014 for the grants of the claims of service connection for right ear hearing loss and tinnitus. The benefit of the doubt doctrine is therefore not for application, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Styer, 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.