Citation Nr: 21076619 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-46 138A DATE: December 27, 2021 ORDER Entitlement to an effective date earlier than April 11, 2016, for the grant of service connection and assignment of a 70 percent evaluation for major depressive disorder is denied. Entitlement to an effective date earlier than January 26, 2017 for the grant of service connection and assignment of a noncompensable rating for bilateral hearing loss disability is denied. Entitlement to an initial compensable rating for bilateral hearing loss disability is denied. Entitlement to a rating in excess of 10 percent for tinnitus is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a sleep disability is denied. Entitlement to service connection for traumatic brain injury (TBI) is denied. Entitlement to service connection for a headache disability is granted. REMANDED Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a rating in excess of 10 percent for cervical strain disability is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) based on service-connected disability is remanded. Entitlement to special monthly compensation (SMC) based on aid and attendance is remanded. FINDINGS OF FACT 1. VA first received the Veteran's claim for service connection for major depressive disorder on April 11, 2016, and his claim for service connection for hearing loss disability on January 26, 2017. 2. At no time during the rating period on appeal has the Veteran's hearing loss been worse than Level I impairment, and referral of this claim for extra-schedular consideration is not warranted because his claimed symptoms are already adequately compensated. 3. The Veteran has the maximum permissible schedular rating for tinnitus; referral of this claim for extra-schedular consideration is not warranted because his claimed symptoms are already adequately compensated. 4. The Veteran is less than credible as to a right knee injury, a left knee injury, and/or a head injury (TBI) in service. 5. The most probative (competent and credible) evidence is against finding that the Veteran has a right knee disability, left knee disability, sleep disability, and/or TBI caused, or aggravated by, service and/or a service-connected disability. 6. Resolving reasonable doubt in the Veteran's favor, service connection for a headache disability is warranted. CONCLUSIONS OF LAW 1. The criteria are not met for entitlement to an earlier effective date for the grants of service connection for major depressive disorder and bilateral hearing loss disability. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 2. The criteria are not met for entitlement to a compensable rating for bilateral hearing loss. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code (DC) 6100. 3. The criteria are not met for a rating higher than 10 percent for tinnitus, including on an extra-schedular basis. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(b)(1), 4.87, DC 6260. 4. The criteria are not met for service connection for a right knee disability, a left knee disability, a sleep disability, and/or TBI. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria are met for service connection for a headache disability. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from May 2005 to August 2010. These matters come before the Board of Veterans' Appeals (Board) from December 2016 and March 2017 rating decisions of a Department of Veterans Affairs (VA), Regional Office (RO). Effective Date Unless specifically provided otherwise, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on a standard form. 38 C.F.R. §§ 3.151, 3.155, 3.157. The amended regulations apply to claims filed on or after March 24, 2015, so including these claims at issue, and do not allow for compensation claims to be based on hospital treatment records, but require the actual filing of the correct form designated by the Secretary of VA. 1. Entitlement to an effective date earlier than April 11, 2016, for the grant of service connection and assignment of a 70 percent evaluation for major depressive disorder. Neither the Veteran nor his representative has provided adequate argument as to why an effective date earlier than April 11, 2016 is warranted. On April 11, 2016, VA received the Veteran's VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits), alleging entitlement to service connection for PTSD. The RO accepted this as a claim for service connection for an acquired psychiatric disability however it may be diagnosed. See Clemons v. Shinseki, 23 Vet. App (2009). There is no evidence in the claims file prior to April 11, 2016, which can reasonably be construed as an earlier attempt to file a claim for service connection for an acquired psychiatric disability. Moreover, as explained above, effective March 24, 2015, all claims must be filed on a standard form. Based on the foregoing, April 11, 2016 is the appropriate effective date for the grant of service connection for major depressive disorder (claimed as PTSD). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Entitlement to an effective date earlier than January 26, 2017 for the grant of service connection and assignment of a noncompensable rating for bilateral hearing loss disability. Neither the Veteran nor his representative has provided adequate argument as to why an effective date earlier than January 26, 2017 is warranted. On January 26, 2017, VA received the Veteran's VA Form 21-526EZ, alleging entitlement to service connection for hearing loss. There is no evidence in the claims file prior to January 26, 2017 which can reasonably be construed as an earlier attempt to file a claim for service connection for a hearing loss disability, and effective March 24, 2015 all claims must be filed on a standard form. Based on the foregoing, January 26, 2017 is the appropriate effective date for the grant of service connection for hearing loss disability. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Increased Rating Disability evaluations are determined by comparing a Veteran's present symptoms with criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R.§ 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. Id. § 4.3. "Staged" ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods when the service-connected disability exhibits symptoms warranting different ratings irrespective of whether an initial or established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. According to 38 C.F.R. § 3.400(o)(2), the effective date in a claim for an increased rating can be up to one year prior to the date of receipt of the increased rating claim provided the evidence reflects a worsening of the disability during that immediately preceding year; in other words, this must be factually ascertainable. See Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). Although the Board may not assign an extra-schedular rating in the first instance, it must specifically adjudicate whether to refer a case for extra-schedular evaluation when the issue either is raised by the claimant or reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). The Court has clarified the analytical steps necessary to determine whether referral for extra-schedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111(2008), affd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). First, there must be a determination of whether the evidence presents such an exceptional disability picture that the available schedular evaluation for the service-connected disability is inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, there must be a determination of whether the Veteran's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the Rating Schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating under 38 C.F.R. § 3.321(b)(1). 3. Entitlement to an initial compensable rating for bilateral hearing loss disability. The Veteran's hearing loss disability is rated as noncompensable under DC 6100 from the effective date of service connection in January 2017. Disability ratings for hearing loss are derived from a "mechanical" (meaning nondiscretionary) application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Ratings for hearing loss range from 0 percent (noncompensable) to 100 percent based on impairment of hearing acuity as measured by speech discrimination tests (Maryland CNC) and pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 Hertz. 38 C.F.R. § 4.85, DC 6100. The results are charted on Table VI or Table VIA. The Rating Schedule establishes 11 auditory acuity levels designated from Level I (for normal hearing) through Level XI (for profound deafness). 38 C.F.R. § 4.85(h). Table VII prescribes the disability rating based on the relationship between the values for each ear derived from Table VI or VIA. 38 C.F.R. § 4.85. VA treatment records are unremarkable for audiology findings which would warrant a compensable evaluation. A February 2017 Disability Benefits Questionnaire (DBQ) with audiology evaluation findings also reflects that the Veteran reported that he cannot hear traffic when he crosses the street, from the left side and that he believes he cannot hear "anything at all from [his] left". The report reflects that relevant puretone air and bone conduction thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT air and bone 35 35 30 35 LEFT air 35 45 50 50 LEFT bone 35 40 45 45 On the basis of the numbers shown above, the Veteran's puretone threshold average for the right ear was recorded as 33.75 decibels. His puretone threshold average for the left ear was recorded as 45 decibels (or 41.24 using bone conduction). His speech recognition ability was 96 percent for the right ear and 94 percent for the left ear using the Maryland CNC speech recognition test. Applying those results to Table VI, he had a Level I impairment in each ear. When applying the levels of impairment shown to Table VII, the Veteran's hearing loss correlates to a 0 percent (noncompensable) rating. The Board also has considered the provisions of 38 C.F.R. § 4.86, but the Veteran's hearing does not meet the criteria for an exceptional pattern of hearing impairment. The Board acknowledges the Veteran's personal lay statements regarding his hearing acuity (lack thereof), and the Board does not dispute that he has hearing loss. However, in determining the actual degree or extent of disability, the objective examination results are more probative of the amount of his impairment than his lay statements. Furthermore, his opinions and observations cannot meet the burden imposed by the rating criteria under 38 C.F.R. § 4.85, DC 6100. See Moray v. Brown, 2 Vet. App. 211, 214 (1993); 38 C.F.R. § 3.159(a)(1) and (2). The Veteran has sufficient hearing loss to meet the threshold minimum requirements of 38 C.F.R. § 3.385 to be considered a ratable disability, and he accordingly is in receipt of service connection for this disability albeit, as mentioned, at the most minimum noncompensable level. However, his hearing loss disability does not rise to the level of severity warranting financial compensation under the applicable rating criteria. In essence, although he has difficulty hearing, his impairment is considered noncompensable according to VA regulations. The rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA's audiometric tests are designed to measure. When "hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the scheduler rating criteria." See Doucette v. Shulkin, 28 Vet. App. 366 (2017); Rossy v. Shulkin, 29 Vet. App. 142 (2017). Recognizing all this, the threshold element for extra-schedular consideration is not met and any further consideration of governing norms or referral to the appropriate VA officials for extra-schedular consideration is unnecessary. Thun v. Peake, 22 Vet. App. 111(2008). The Veteran has not alleged, and the evidence does not otherwise show, any symptoms or impairment indicative of an unusual or unique disability picture not contemplated by the rating criteria; thus, the schedular criteria are wholly adequate. As a result, extra-schedular referral is not required. 38 C.F.R. § 3.321(b)(1); Bagwell v. Brown, 9 Vet. App. 337(1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). As the preponderance of the evidence is against this claim, the benefit of the doubt rule is not applicable since there is not at least relative balance of evidence for versus against this claim. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 4. Entitlement to an increased rating for tinnitus. The Veteran's tinnitus is rated as 10-percent disabling under the schedular rating criteria. There is no higher schedular rating for tinnitus. 38 C.F.R. § 4.87, DC 6260, Note (2); see also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). The Veteran has described having tinnitus (i.e., ringing in his ears) and that, due to it, he finds himself speaking louder than normal. See February 2017 DBQ. Tinnitus is a noise in the ear, such as ringing, buzzing, roaring, or clicking. See Dorland's Illustrated Medical Dictionary (33rd ed. 2020). Acknowledging this, it stands to reason tinnitus may have some effect on the Veteran feeling the need to speak at a louder level. However, the Board finds that this is not a symptom, but a reaction, and even so, the 10 percent rating for the Veteran's tinnitus adequately compensates him for all his associated symptoms and consequent functional impairment. The Board finds that referral to the Director of Compensation Services for extra-schedular consideration is not warranted. Not only does he not have symptoms which are not considered under the rating code, but he has not shown, and it is not suggested, by probative evidence that his tinnitus has caused factors such as marked interference with employment or frequent hospitalizations. Service Connection In general, establishing service connection requires medical evidence or, in certain circumstances, lay evidence of the following: (1) a current disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a nexus between the disease or injury in service and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In addition, certain chronic diseases including arthritis will be presumed to have been incurred in service, absent an intervening ("intercurrent") cause, if they were shown as chronic in service or if they manifested to a compensable degree within a year following separation from service, or if they were noted in service (or within the presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). According to 38 C.F.R. § 3.310, service connection may be granted on a secondary basis, for disability that is proximately due to, the result of, or aggravated by a service-connected disability although in the latter instance compensation is limited to the disability specifically owing to the aggravation. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). For the claims denied below, the Board finds that the Veteran has not been shown to have the experience, training, or education necessary to give a probative opinion regarding diagnosis and/or the origins of a knee disability, a sleep disability, and/or TBI, including in terms of whether related or attributable to anything that occurred during his time in the military or to a service-connected disability. This determination is beyond his lay competence. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). See also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). 5. Entitlement to service connection for a right knee disability 6. Entitlement to service connection for a left knee disability The Veteran's service treatment records (STRs) are unremarkable for complaints of the knees. His February 2010 Report of Medical History (DD Form 2807-1) reflects that he specifically denied knee trouble, and denied that he required the use of any corrective devices such as knee braces. The Board notes that the Veteran reported more than a dozen complaints. Thus, if he had knee complaints, it would have been reasonable for him to have reported it when he reported his other complaints. Instead, he specifically denied knee complaints. On a February 2010 DD Form 2697 (Report of Medical Assessment), he reported that he had headaches, his shoulder hurts, that his neck and ear are worse, that he had back complaints, and that he had wrist complaints. Again, the report is unremarkable for knee complaints. The Veteran separated from active service in 2010. In 2017, he submitted claims for service connection for right and left knee disabilities by filing a VA Form 21-526EZ. Under the framework for a fully developed claim (FDC), a claim is submitted in a "fully developed" status, limiting the need for further development of the claim by VA. When filing a fully developed claim, a veteran submits all evidence relevant and pertinent to his or her claim other than STRs and treatment records from VA medical centers (VAMCs), which will be obtained by VA. The fully developed claim form included notice to the veteran of what evidence is required to substantiate a claim for service connection and apprised him of his and VA's respective responsibilities in obtaining this necessary supporting evidence. There are no clinical records reflecting a diagnosis of a knee disability. The Veteran is competent to report symptoms such as pain and/or stiffness. However, a mere symptom, without a diagnosed or identifiable underlying malady or condition or associated functional impairment of earning capacity, does not, in and of itself, constitute a "disability" for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). That said, the Board also is cognizant of the Court's ruling in Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018), that pain alone sometimes can constitute a ratable disability. But the Court in Saunders cautioned that a Veteran cannot demonstrate service connection simply by asserting subjective pain. Rather, "[t]o establish the presence of a disability, the veteran will need to show that [his or] her pain reaches the level of functional impairment of earning capacity." Id. Moreover, attribution of the disability to the Veteran's service still is required. In the present situation, the VA treatment records do not reflect chronic knee complaints, and the Veteran has not submitted statements as to chronic knee symptoms impairing his earning capacity. Moreover, assuming arguendo, that he has current symptoms and/or a diagnosis, the evidence is against finding there has been continuity of symptoms since service. As noted above, in February 2010, he denied knee complaints. There are no clinical records in the next several years noting knee complaints. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). See also Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). There is also no probative evidence that he has a current knee disability causally related to, or aggravated by, service. Any opinion based on a contention of continuity of symptoms since service would lack probative value as it would be based on a less than credible history. The Veteran has been provided every opportunity to submit evidence and argument in support of his claims; however, he has failed to provide competent and credible evidence indicating an association between a claimed knee disability and his service and/or a service-connected disability. His mere lay assertions (e.g., his claim), alone, are insufficient to warrant VA having him examined for medical opinions. See Waters v. Shinseki, 601 F.3d 1274, 1279 (Fed. Cir. 2010) (the Veteran's mere conclusory lay statement is insufficient to trigger VA's duty to assist by providing an examination for a medical opinion). In the absence of probative evidence of a disability, and in the absence of probative evidence that any such disability is as likely as not causally related to, or aggravated by, service and/or a service-connected disability, service connection is not warranted. His claims are denied. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. 7. Entitlement to service connection for a sleep disability. The Veteran's claim was filed using a VA Form 21-526EZ, which included notice to the Veteran of what evidence is required to substantiate a claim for service connection and apprised him of his and respective responsibilities in obtaining this necessary supporting evidence. The Veteran failed to specify as to the nature of his claimed "sleep condition", but merely listed it as such. His February 2010 Report of Medical History (DD Form 2807-1) reflects that he cannot sleep sometimes because of headaches, ear pain, and shoulder pain. However, it was not noted to be an actual sleep disability, but rather that pain from other conditions kept him awake at times. A July 2016 DBQ for the Veteran's mental health reflects that he was diagnosed with major depressive disorder which included "depressed mood, feelings of worthlessness, insomnia, difficulty concentrating, and fatigue." A March 2020 DBQ reflects that the Veteran's major depressive disorder with psychotic features, and his stimulant use disorder result in chronic sleep impairment. The Veteran is in receipt of service connection for major depressive disorder, which is evaluated as 70 percent disabling under DC 9434. The 70 percent rating sufficiently compensates the Veteran for his sleep impairment as it is a symptom which is listed as an example in the rating code for a lesser 30 percent rating. The evidence does not reflect that the Veteran has a sleep disability separate and apart from his service-connected major depressive disorder. For example, he has not alleged, and the evidence does not support, a finding of sleep apnea, narcolepsy, or restless leg syndrome. Based on the above, service connection for a sleep disability is not warranted. 8. Entitlement to service connection for TBI. The Veteran's STRs are unremarkable for objective evidence a head injury. A February 25, 2010 STR entitled "Retirement/Separation from Active Duty" reflects that he served in an imminent danger zone and that he was screened for PTSD/TBI, but he does not have such. On his corresponding Report of Medical History, the Veteran specifically denied having ever had a head injury, but noted that he had headaches. On the Report of Medical Assessment, for the question regarding whether he has suffered from any injury or illness on active duty for which he did not seek medical care, he wrote "Head", and the health care provider comments note "recurrent headaches". The three forms do not support an actual head injury, but rather that he denied a head injury, while reporting headaches. If he had an actual physical head injury such as being hit by an object, it seems entirely reasonable that he would have reported it when discussing headaches, rather than specifically denying it. More than four years after separation from service, a May 2015 VA clinical record reflects that the Veteran reported being in the vicinity of blasts, and being thrown to the ground. He reported that he had lost consciousness on one occasion for less than 30 minutes, and that he had been disoriented or had confusion immediately following an incident on two occasions. The Veteran reported that in 2007 while loading a bomb on a jet, it struck him in the head and knocked him down, causing him to loss consciousness. He reported that he was given rest for three days. The Board finds him less than credible as to his contentions. Not only are the STRs unremarkable for a head injury with loss of consciousness, but the Veteran, in February 2010, specifically denied both a head injury and loss of consciousness. The Board finds that the STRs, which are contemporaneous to service, are more credible than the statements made years later and/or for compensation purposes. See Cartright v. Derwinski, 2 Vet. App.24, 25 (1991) (finding that, while the Board may not ignore a Veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits, personal interest may affect the credibility of the evidence); see also Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995) (credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, facial plausibility of the testimony, and the consistency of the testimony.) The STRs do note complaints of neck pain; however, it was noted to be due to doing "shrugs" with weights. It was also noted that he had a prior injury from snowboarding seven years earlier (see July 2008 STR). The Board find that if the Veteran had been hit in the head/neck with a bomb in approximately 2007, and lost consciousness at that time, it would reasonably have been noted when he sought treatment for a neck complaint in 2008. In April 2016, the Veteran filed a claim for service connection for TBI. A July 2016 DBQ for TBI reflects that it is less likely as not that the Veteran has a TBI, or residuals of such. The Veteran reported that he was struck by a 1000 lb bomb while loading it. He reported that he was knocked unconsciousness for approximately a minute, was given quarters for a week, and then had physical therapy afterwards. The examiner considered the Veteran's report as to a blast explosion, and also considered the Veteran's reported symptoms, to include difficulty with remembering tasks, depression, anxiety, and PTSD, but the examiner found the symptomatology was not attributable to TBI. The examiner found no objective evidence to support that the Veteran was hit in the head and had a short loss of consciousness. The examiner stated that it is unlikely that, even if the Veteran did incur a mild TBI in service, he is having symptoms eight years later. The examiner noted that according to the World Health Organization collaborating center task force on mild TBI, symptoms largely resolve within a few months post injury, with most studies suggesting resolution within three months. The examiner found that the Veteran's symptoms were most likely secondary to his mental health diagnosis. The Board also notes that a March 2020 private DBQ (H. H.-G.) reflects that the Veteran does not have a diagnosed TBI. Any contention as to a head injury in service with TBI is less than credible given the record as a whole, to include the lack of supporting STRs, the STRs noting neck complaints due to lifting weights (and not a TBI), and the Veteran's 2008 denial of a head injury or loss of consciousness in service. Any clinical opinion based on a less than credible history lacks probative value. The most probative evidence is against finding that the Veteran had TBI in service. For these reasons and bases, service connection is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 9. Entitlement to service connection for a headache disability. The Veteran's February 2005 Report of Medical History (DD 2807-1) for enlistment purposes reflects that he reported that he was currently on medication (Motrin) for headaches. He denied current or frequent headaches but noted that he takes Motrin for "mild" headaches which are "never incapacitating". His STRs note one headache in November 2006 when he had an upper respiratory infection. On his February 2010 Report of Medical Assessment for separation purposes, the Veteran reported that he has "bad headaches" and "my head aches". On his Report of Medical History, he noted that he has "occasional headaches" when he clarified why he checked that he had "frequent or severe headaches". A May 2015 VA clinical record reflects that he reported chronic moderate headaches. He was assessed with chronic tension headaches, which were noted to resolve without treatment. He reported an onset after returning from the Persian Gulf in 2007. He reported that he had headaches three times a week, lasting up to three hours. A February 2017 DBQ reflects his statement as to onset in 2010 and that he first noted headaches in service, but they have increased over the years and now occur weekly. He reported that they occur when his service-connected neck pain is particularly severe, and he feels nauseated. He reported that he takes acetaminophen and ibuprofen. He was assessed with headaches consistent with tension headaches. The examiner opined that the headaches were less likely as not related to service, but did not discuss whether they were related to, or aggravated by, a cervical strain disability. A December 2019 VA record reflects that the Veteran reported a five-to-six-week history of headaches progressing in frequency and severity. A January 2020 VA treatment record reflects that the Veteran reported intermittent headaches for years. He was diagnosed with headaches and cervicalgia (i.e., neck pain). An April 2020 private DBQ (Dr. M. B.) reflects that the Veteran reported that he began experiencing headaches while he was in service. He reported that they have increased in both frequency and severity over the years to the point where he will have 6-10 prostrating attacks per month requiring him to lie down for four hours of relief. The examiner (Miranda Blevins) stated that medical research shows that anxiety and depression facilitate the onset of headaches and that patients with chronic headache pain present with high levels of anxiety and depressive symptoms. She noted that psychologic stress can be a predisposing factor and/or exacerbate headaches. She stated that in her opinion, it is as likely as not that this Veteran's chronic headache pain began in service and is both precipitated and aggravated by his lumbar spine disability, cervical spine disability, and major depressive disorder. The claims file includes an article "headache and mood disorders" which notes that a study showed that "anxiety and depression facilitate the onset of headache". Another article "Understanding Psychologic Stress, its Biological Processes, and impact on Primary Headache", which notes that stress plays a prominent role in headache. Thus, the articles generally support Dr. Blevins position. The Veteran is in receipt of service connection for major depressive disorder; a 2020 DBQ reflects that he has difficulty adapting to stressful situations and has anxiety. The Veteran is also in receipt of service connection for several other disabilities, including cervical strain (e.g., neck strain) and lumbar strain. The Veteran is less than credible that his headaches began in service, because as noted above, he specifically reported experiencing "mild" headaches when he enlisted. Thus, Dr. Blevins opinion lacks significant probative value in that regard. However, the Board also recognizes that the Veteran reported "bad" headaches upon separation from service, which can be seen as an increase in severity from "mild". In addition, the Board acknowledges that he has three service-connected disabilities which may aggravate headaches. Thus, in resolving reasonable doubt in the Veteran's favor, service connection for a headache disability is granted. REASONS FOR REMAND 10. Entitlement to service connection for PTSD. In April 2016, the Veteran filed a claim for service connection for PTSD. As noted above, the RO accepted this as a claim for service connection for an acquired psychiatric disability however it may be diagnosed. See Clemons v. Shinseki, 23 Vet. App (2009). A July 2016 DBQ reflects a diagnosis of major depressive disorder, and that the Veteran does not meet the diagnosis for PTSD. (In addition, a March 2020 private DBQ also notes a diagnosis of major depressive disorder.) In a December 2016 rating decision, the RO granted service connection for major depressive disorder (claimed as PTSD). In January 2017, the Veteran contended that his "PTSD has gotten so bad that I can't seem to get along with anyone", and he filed for service connection for PTSD. In a March 2017 rating decision, the RO denied service connection for PTSD. The Veteran has appealed that denial. Entitlement to service connection is distinct from entitlement to compensation. The Veteran's major depressive disorder is rated under DC 9434, which uses the same criteria regardless of the specific acquired psychiatric disability which is in receipt of service connection. Rather, the diagnosed disability (e.g., major depressive disorder, PTSD, general anxiety disorder) is rated under the General Rating Formula For Mental Disorders. The rule against pyramiding prevents a claimant from being compensated more than once for disabilities with the same symptoms. However, it does not preclude a claimant from establishing that a disability, that may have overlapping symptoms with an already service-connected disability, is related to service. See McCray v. McDonald, No. 14-0136, 2015 U.S. App. Vet. Claims LEXIS 646 (2015). VA treatment records reflect that the Veteran has a prior medical history of PTSD; however, this appears to have been based on the Veteran's reported history because the claims file does not reflect a diagnosis of PTSD under the DSM-5. A July 2016 DBQ reflects the opinion of the examiner that the Veteran does not meet the criteria for PTSD, but instead, he has major depressive disorder. However, she failed to provide rationale as to why he did not meet the criteria for PTSD. Thus, a supplemental opinion may be useful to the Board prior to adjudication. The Board also notes that the Veteran has claimed a variety of stressors: 1. seeing people crushed in an elevator; 2. being near IED explosions; 3. seeing someone's arm almost ripped off/ripped off and the death of the person; and 4. seeing a helicopter crash onboard the USS Abraham with the death of shipmates. If the addendum opinion is based on a lack of verified stressors, VA should attempt to verify them. If the addendum opinion is based on a lack of symptoms to warrant a diagnosis of PTSD, verification of alleged stressors is not warranted. The Veteran has reported that he was treated at the Augusta Georgia VAMC from January 2010 to January 2014, and thereafter, at the Houston VAMC from January 2014 to April 2016. An April 2016 Report of General Information (VA Form 27-0820) reflects that there are no records for the VAMC Augusta, Georgia from January 1, 2010 to December 28, 2010. The claims file includes records from December 2010 through August 2012. However, the Board is unsure if the RO attempted to obtain records from August 2012 to January 2014 from Augusta, Georgia. In addition, although the June 2020 Statement of the Case (SOC) notes that VA received certification on April 28, 2016 that pertinent treatment records from VAMC Houston from January 1, 2014 through March 10, 2015 do not exist, the Board does not see this certification in the record. Thus, further development for these records is warranted prior to the VA examiner's supplemental opinion. 11. Entitlement to a rating in excess of 10 percent for cervical strain disability. The Veteran's cervical spine strain is evaluated as 10 percent disabling under DC 5237 effective from August 2010. In January 2017, he filed a claim for an increased rating. In October 2020 correspondence, the Veteran's attorney stated: "mental status examination dated February 4, 2016 reports difficulty getting out of bed daily due to neck pain and takes 15-20 min to get started with his day due to neck and back pain." The Board is unable to find this record associated with the claims file. The Veteran's attorney also cited to a "consultative exam dated March 5, 2016" which "reports cervical spine range of motion 50 degree flexion, 30 degree extension" and that the Veteran was noted to be able to do "sedentary physical demand level work but will have difficulty with full time employment due to the control nature of his radicular pain and his low back and cervical spine pain." The Board notes that normal forward flexion for the cervical spine is only to 45 degrees.) However, again, the Board is unable to find this record associated with the claims file. VA should attempt to obtain these records, as well as updated VA treatment records. (The most recent VA treatment record is from February 2020.) 12. Entitlement to a TDIU. 13. Entitlement to special monthly compensation. In the decision above, the Board has granted service connection for a headache disability. Thus, the RO must now assign a rating and an effective date. The Board's adjudication of the issues of entitlement to a TDIU and entitlement to SMC is premature prior to RO action. In October 2020 correspondence, the Veteran's attorney stated that a February 4, 2016 record reflects that Veteran's mother prepares his meals, handles his finances, and reminds him to take his medications. However, a January 2017 VA Form 21-4138 reflects that the Veteran reported that most of the day, he helps his disabled mother around the house and takes her places. The attorney also stated that the record reflects that the Veteran reported that he stopped working past jobs due to neck problems, impatience and difficulty getting along with others. However, the Veteran has also previously stated that he had lost his job due to repossession of his vehicle (see January 2017 VA Form 21-4138), and that he has lost jobs due to drug usage. The Veteran has reported that he recently attempted to work in June 2021. He should be requested to submit a VA Form 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits) for his last two employers. The matters are REMANDED for the following action: 1. Attempt to obtain VA treatment records, if any, for the Veteran from August 2012 to January 2014 at the Augusta, Georgia VAMC, and from January 2014 to March 2015 at the from the Houston, Texas VAMC. If records are unavailable, annotate this in the file and provide notice to the Veteran. 2. Request the Veteran to provide VA with the February 4, 2016 and March 5, 2016 clinical records/examination reports which were cited by his attorney in October 2020 correspondence. 3. Obtain a supplemental opinion to the July 2016 DBQ. The examiner should provide adequate rationale as to why the Veteran does not meet the diagnostic criteria for PTSD. (The clinician should state which criteria are not met.) If an adequate rationale cannot be provided without another examination, schedule the Veteran for one. If, alternatively, the examiner finds that the Veteran meets the criteria for PTSD, the examiner should provide a rationale to support such a finding and state what claimed stressor supports the diagnosis. 4. If, and only if, the evidence reflects that the Veteran meets the criteria for PTSD, attempt to verify his claimed stressor(s), noted by the examiner. 5. Effectuate the grant of service connection and assign an initial rating and effective date for headaches. 6. Then request the Veteran complete and return a VA Form 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits) for his last two employers. (He did not provide this information when completing the form in 2017 and has stated that he worked for one day in June 2021.) Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Wishard 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.