Citation Nr: 21006821 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 16-39 138 DATE: February 5, 2021 ORDER New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for a traumatic brain injury (TBI) (previously denied as gunshot wound to the head) is denied. New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for headaches is denied. New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for hypertension is denied. New and material evidence having been received, the appeal to reopen the claim for entitlement to service connection for a left knee disability is granted. New and material evidence having been received, the appeal to reopen the claim for entitlement to service connection for glenohumeral joint and acromioclavicular joint osteoarthritis of the right shoulder (hereafter referred to as a “right shoulder disability”), to include as secondary to service-connected status post arthroscopic acromioplasty, subacromial decompression and acromioclavicular joint resection of the left shoulder (hereafter referred to as a “left shoulder disability”), is granted. New and material evidence having been received, the appeal to reopen the claim for entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for hemorrhoids 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 bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for gastroesophageal disease (GERD) is denied. Entitlement to service connection for PTSD is denied. Entitlement to an effective date earlier than July 6, 2018, for the award of service connection for depressive disorder is denied. Entitlement to an initial disability rating in excess of 70 percent for service-connected depressive disorder is denied. Beginning July 6, 2018, entitlement to total disability based on individual unemployability (TDIU) is granted. Entitlement to automobile or other conveyance and adaptive equipment or adaptive equipment only is denied. REMAND Whether new and material evidence has been received to reopen the claim for entitlement to service connection for degenerative changes with partial disc desiccation L4-L5, L5-S1 with mild flattening L5-S1 disc (hereafter referred to as a “low back disability”), to include as secondary to service-connected left shoulder disability, is remanded. Entitlement to service connection for radiculopathy of the right lower extremity is remanded. Entitlement to service connection for radiculopathy of the left lower extremity is remanded. Entitlement to service connection for cervical spine degenerative disease with moderate disc disease, status post anterior cervical discectomy C4-C5, and C-5-C6 with residuals (hereafter referred to as a “neck disability”), to include as secondary to service-connected left shoulder disability and/or a bilateral knee condition, is remanded. FINDINGS OF FACT 1. The evidence associated with the claims file since the November 2009 final denial does not include evidence that relates to an unestablished fact necessary to substantiate the claim, is cumulative or redundant of the evidence previously of record, or is insufficient to raise a reasonable possibility of substantiating the claim for service connection for a TBI (previously denied as a gunshot wound to the head). 2. The evidence associated with the claims file since the November 2009 final denial does not include evidence that relates to an unestablished fact necessary to substantiate the claim, is cumulative or redundant of the evidence previously of record, or is insufficient to raise a reasonable possibility of substantiating the claim for service connection for headaches. 3. The evidence associated with the claims file since the March 2014 final denial does not include evidence that relates to an unestablished fact necessary to substantiate the claim, is cumulative or redundant of the evidence previously of record, or is insufficient to raise a reasonable possibility of substantiating the claim for service connection for hypertension. 4. The evidence associated with the claims file since the March 2014 final denial includes evidence that relates to an unestablished fact necessary to substantiate the claim, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim for service connection for a left knee disability. 5. The evidence associated with the claims file since the November 2009 final denial includes evidence that relates to an unestablished fact necessary to substantiate the claim, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim for service connection for a right shoulder disability. 6. The evidence associated with the claims file since the August 2008 final denial includes evidence that relates to an unestablished fact necessary to substantiate the claim, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim for service connection for PTSD. 7. The evidence of record is against finding that the Veteran has had hemorrhoids at any time during, or approximate to, the pendency of the claim. 8. The evidence of record is against finding that the Veteran has had a right knee disability at any time during, or approximate to, the pendency of the claim. 9. The evidence of record is against finding that the Veteran has had a left knee disability at any time during, or approximate to, the pendency of the claim. 10. The evidence of record is against finding that the Veteran has had bilateral hearing loss at any time during, or approximate to, the pendency of the claim. 11. The evidence of record is against finding that the Veteran’s tinnitus occurred in, or is the result of, his period of active duty service. 12. The evidence of record is against finding that the Veteran’s GERD occurred in, or is the result of, his period of active duty service. 13. The evidence of record is against finding that the Veteran’s PTSD occurred in, or is the result of, his period of active duty service. 14. The Veteran filed for service connection for a psychiatric condition on July 6, 2018. 15. The Veteran’s service-connected depressive disorder more closely approximates occupational and social impairment in most areas. 16. Beginning July 6, 2018, the Veteran’s service-connected depressive disorder renders him unable to secure or follow a substantially gainful occupation. 17. The Veteran is not service-connected for a condition that has resulted in loss or permanent loss of use of one or both feet; loss or permanent loss of use of one or both hands; permanent impairment of vision of both eyes; severe burn injury precluding effective operation of an automobile; amyotrophic lateral sclerosis; or ankylosis of one or both knees or one or both hips. CONCLUSIONS OF LAW 1. Evidence received since the November 2009 rating decision is not new and material, and reopening of the Veteran’s claim for entitlement to service connection for a TBI (previously denied as a gunshot wound to the head) is not warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 2. Evidence received since the November 2009 rating decision is not new and material, and reopening of the Veteran’s claim for entitlement to service connection for headaches is not warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 3. Evidence received since the March 2014 rating decision is not new and material, and reopening of the Veteran’s claim for entitlement to service connection for hypertension is not warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 4. Evidence received since the March 2014 rating decision is new and material, and reopening of the Veteran’s claim for entitlement to service connection for a left knee disability is warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 5. Evidence received since the March 2014 rating decision is new and material, and reopening of the Veteran’s claim for entitlement to service connection for a right shoulder disability is warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 6. Evidence received since the March 2014 rating decision is new and material, and reopening of the Veteran’s claim for entitlement to service connection for PTSD is warranted. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 19.20, 19.21, 19.52(a). 7. The criteria for entitlement to service connection for hemorrhoids are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for entitlement to service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for entitlement to service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for entitlement to service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.655, 3.385. 11. The criteria for entitlement to service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a)–(b), 3.307(a)(3), 3.309(a). 12. The criteria for entitlement to service connection for GERD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 13. The criteria for entitlement to service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 14. The criteria for entitlement to an effective date earlier than July 6, 2018, for the award of service connection for depressive disorder are not met. 38 U.S.C. §§ 5107, 5110(a)–(b); 38 C.F.R. §§ 3.102, 3.400(b)(2)(i). 15. The criteria for entitlement to a disability rating in excess of 70 percent for service-connected depressive disorder are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code (DC) 9434. 16. Beginning July 6, 2018, the criteria for entitlement to TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16(a). 17. The criteria for establishing eligibility for financial assistance for an automobile and/or adaptive equipment are not met. 38 U.S.C. §§ 3901, 3902, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.808. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Also currently pending before VA are claims for entitlement to service connection for a bladder condition, erectile dysfunction, and obstructive sleep apnea. Those claims are under the jurisdiction of the Appeals Modernization Act, and the Veteran currently is in the process of seeking a higher-level review by the RO. See November 12, 2020, VA Form 20-0996. Thus, those claims will not be discussed herein. The Veteran served on active duty from May 1985 to March 1988 and May 1999 to July 2000 with periods of United States Army Reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. For a large portion of these claims, Counsel has offered no argument or theory of entitlement. Unless otherwise noted for each issue at the outset, it can be assumed that none was advanced as to that particular issue. New and Material Evidence VA may reopen a claim that previously has been denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). New evidence is evidence not previously submitted to agency decision makers, and material evidence is 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 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). Regarding the newly submitted evidence, the United States Court of Appeals for Veterans Claims (Court) has held that 38 C.F.R. § 3.156(a) must be read as creating a low threshold, which suggests a standard that would require reopening if newly submitted evidence, combined with VA assistance and considering the other evidence of record, raises a reasonable possibility of substantiating the claim. Shade v. Shinseki, 24 Vet. App. 110, 117–18 (2010). Furthermore, the Court has held that evidence as to each previously unproven element of a claim is not required for the claim to be reopened. Id. at 121. VA is required to review for newness and materiality only the evidence submitted by a claimant since the last final disallowance of the claim on any basis, whether a decision on the underlying merits or a petition to reopen. Evans v. Brown, 9 Vet. App. 273, 283 (1996). In determining whether the evidence presented or secured since the prior final disallowance of the claim is new and material, the credibility of the evidence generally is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Court has held that a new etiological theory does not constitute a new claim. Roebuck v. Nicholson, 20 Vet. App. 307, 313 (2006); Ashford v. Brown, 10 Vet. App. 120, 123 (1997). While a new theory of entitlement cannot be the basis to reopen a claim under 38 U.S.C. § 7104(b), if the evidence supporting a new theory of entitlement constitutes new and material evidence, then VA must reopen the claim under 38 U.S.C. § 5108. Boggs v. Peake, 520 F.3d 1330, 1336–37 (Fed. Cir. 2008). Regardless of any RO determinations that new and material evidence has been submitted to reopen a previously denied claim, the Board still must review whether new and material evidence has been submitted. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). For the new and material evidence claims, the Board recognizes that, prior to the relevant final denials, which will be discussed in more detail below, the RO had available to it the Veteran’s service treatment records (STRs), military personnel records (MPRs), various post-service medical evidence—both VA and private—as well as lay statements from the Veteran. Following the most recent final denials, the record contains updated private treatment records, VA medical center (VAMC) records, VA examinations, and lay statements. Any relevant evidence will be discussed as it pertains to each issue. 1. New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for a TBI (previously denied as gunshot wound to the head) is denied. On his March 2000 separation report of medical history (RMH), the Veteran indicated that he suffered, in 1990, a head injury described as a gunshot wound to the head. The Veteran noted that a hospital removed the bullet, but CT scan and x-rays showed no problems. As a result, however, the Veteran stated that he experienced occasional dizziness. The Veteran originally was denied entitlement to service connection for a gunshot wound to the head in a November 2009 rating decision. That determination noted that the STRs failed to document such an incident during active service or in the line of duty; however, the medical evidence showed a head injury in 1990 without chronic impairment. Since the most recent denial, there has been a substantial amount of evidence added to the claims file, as noted above, all of which the Board recognizes is new. Although new, the evidence is not material. Neither Counsel nor the Veteran have provided any evidence that speaks to an unestablished fact that raises a possibility of substantiating the Veteran’s claim. While the VAMC records contain a few notations that the Veteran, according to himself, experienced a gunshot wound during service, that allegation previously was considered by the RO, so it is considered redundant of the evidence previously of record. There is no evidence that discusses any other alleged in-service event that could be responsible for the Veteran’s claimed condition. Thus, the Veteran has not presented new and material evidence for this claim, so the RO’s determination to deny reopening is correct. See 38 C.F.R. § 3.156(a). 2. New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for headaches is denied. The Veteran’s claim for headaches originally was denied in a June 2001 decision, which simply noted that there was no treatment for headaches while in service. A November 2009 rating decision denied reopening because new and material evidence was not submitted. During those times, the Veteran advanced no theory of entitlement. Currently, the Veteran argues that his headaches are secondary to his TBI/post-concussive syndrome. See July 16, 2018, VA Form 21-526EZ. In a November 2020 Brief, Counsel summarized various pieces of evidence submitted. One such piece of evidence is an opinion from Dr. M.B., which, as summarized by Counsel, states the following: After review of the claims file and interviewing the Veteran on September 21, 2020, [Dr. M.B.] opines the Veteran is experiencing very frequent prostrating and prolonged attacks of headache pain productive of severe economic inadaptability and she believes it is as least as likely as not his chronic headache pain is proximately caused by his service connected depressive disorder and chronic left shoulder pain as well as his cervical spine pain. She further opines the interaction between these risk factors cannot be quantified with verifiable data and it cannot be determined which is [a] bigger factor for causation. She cited medical research to support her opinion. As noted above, a new etiological theory, in and of itself, cannot serve as the basis to reopen a previously denied claim unless there is new and material evidence to support that theory. Thus, the belief that the Veteran’s headache condition is related to any of his other service-connected conditions can serve as the basis to reopen only where there is new and material evidence submitted to support that proposition. See Boggs, 520 F.3d at 1336–37. Because the Board herein has denied reopening the Veteran’s claim for service connection for a TBI, that theory cannot serve as the basis to reopen his claim for headaches. See id.; 38 C.F.R. § 3.156(a). With respect to the other allegations of secondary service connection for headaches, the Board finds the evidence is misrepresented. While the record does contain a September 21, 2020, medical opinion from Dr. M.B., it speaks only to the severity of the Veteran’s service-connected psychiatric condition, as well as his employability. Nowhere—not once—does the opinion mention the word “headaches”; yet, Counsel asserts that Dr. M.B. positively has linked the Veteran’s headaches to his service-connected depressive disorder and left shoulder condition, as well as his cervical pain. To be sure, there is only one opinion from Dr. M.B. in the record, and it is dated September 21, 2020—the same date on which Counsel alleges that Dr. M.B. evaluated the Veteran for his headaches. In the very opening paragraph of that opinion, Dr. M.B. states: “I have been asked to render a medical opinion if [the Veteran’s] service connected conditions would have any impact on his ability to work.” Thus, Dr. M.B. was not even asked to opine on the etiology of the Veteran’s headaches or discuss their severity/nature. With only Counsel’s mischaracterization of the evidence to support the theory that the Veteran’s headache condition is secondary to another service-connected condition, the Board cannot conclude that such statements are new and material. Thus, the record contains no new and material evidence as to the claim for entitlement to service connection for headaches, and the RO properly determined that reopening was not warranted. See 38 C.F.R. § 3.156(a). 3. New and material evidence not having been received, the appeal to reopen the claim for entitlement to service connection for hypertension is denied. The Veteran’s hypertension claim originally was denied in a June 2001 rating decision for lack of in-service evidence of hypertension. Both a September 2010 rating decision and the one currently on appeal denied reopening that claim for lack of new and material evidence. Medical evidence at the time of this decision shows the Veteran carried a diagnosis of essential hypertension. While the evidence since the September 2010 final denial is new, it is not material. Medical records, both VA and private, continue to show that the Veteran is treated for hypertension, but neither the Veteran nor Counsel has proffered any evidence regarding the in-service (second) element for his claim. As there exists no evidence that is not cumulative of the evidence previously of record that would raise a reasonable possibility of substantiating the Veteran’s claim, the evidence since the September 2010 final denial is not new and material, and the RO’s decision to deny reopening the Veteran’s claim was proper. See 38 C.F.R. § 3.156(a). 4. New and material evidence having been received, the appeal to reopen the claim for entitlement to service connection for a left knee disability is granted. The Veteran’s claim for entitlement to service connection for a left knee disability most recently was denied in an August 2010 rating decision, which noted that the Veteran did not have a diagnosed condition of the left knee. The decision on appeal declined to reopen the Veteran’s claim for this condition because no new and material evidence was submitted. The Board disagrees. Since the Veteran’s appeal, the law regarding what constitutes a current disability has changed. For the purposes of service connection, pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). VAMC records from March and August 2018 show that the Veteran has complained of bilateral stiffness and pain in his knees. These characterizations of the Veteran’s complaints are indicative of potentially objective evidence of functional impairment; and qualifies as new and material evidence under a Saunders analysis. Therefore, the Board finds that reopening of this claim is appropriate. See id.; 38 C.F.R. § 3.156(a). 5. New and material evidence having been received, the appeal to reopen the claim for entitlement to service connection for a right shoulder disability, to include as secondary to service-connected left shoulder disability, is granted. This claim most recently was the subject of a November 2009 final denial. At that time, the claim was denied because there was no clinical diagnosis of a right shoulder disability. The medical evidence submitted since that time shows that the Veteran has the diagnosed right shoulder condition identified on this decision’s first page. That is new and material evidence, as it previously was not before VA adjudicators and speaks to an unestablished fact, which raises a reasonable possibility of substantiating the Veteran’s claim. Thus, VA made the correct determination to reopen this claim and assess it on the merits. See 38 C.F.R. § 3.156(a). 6. New and material evidence having been received, the appeal to reopen the claim for entitlement to PTSD is granted. In an August 2008 prior, final denial, the Veteran was denied entitlement to service connection for PTSD due to lack of a clinical diagnosis and verified stressor. At that time, the Veteran alleged that he witnessed his friend die during a plane crash while stationed in Iraq. An August 2008 VA Memorandum indicated that the Veteran’s alleged stressor could not be verified for lack of sufficient detail. Since then, the Veteran has indicated that his PTSD also is the result of attempting to assist someone in a domestic violence incident. See July 6, 2018, VA Form 21-0781a. VAMC treatment records from January 2018 also show that the Veteran receives treatment for PTSD. This evidence is new and material, and the Board determines that reopening of these claims is warranted. See 38 C.F.R. § 3.156(a). Service Connection For disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war or peacetime, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131. To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). To establish secondary service connection, a veteran must provide evidence of (1) a current, non-service-connected disability, (2) a current service-connected disability, and (3) evidence that the non-service-connected disability is either (i) proximately due to or the result of a service-connected disability or (ii) aggravated (increased in severity) beyond natural progression by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 446 (1995); 38 C.F.R. § 3.310. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit). In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 1335–37 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. 7. Entitlement to service connection for hemorrhoids is denied. The Veteran has not offered any argument with respect to this claim (as with so many others). The most he has done is file a claim seeking entitlement to benefits. STRs do not contain complaints of, treatment for, or diagnosis of hemorrhoids. The post-service evidence also discloses that the Veteran does not receive treatment for hemorrhoids. The medical evidence from VA, SSA, and his private providers, do not show treatment or diagnosis for hemorrhoids. The Veteran also fails to offer any statement discussing what could even be construed as symptoms that might be diagnosed as hemorrhoids. Hemorrhoids are a common malady with a multitude of symptoms capable of lay observation and diagnosis. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The record, however, is void of any evidence—lay or medical—that assists the Board in substantiating a current diagnosis. Because hemorrhoids have a variety of symptoms, merely filing a claim for hemorrhoids is not enough. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (holding that the duty to assist is not a one-way street). Thus, without any medical evidence of a diagnosis, or even a description of symptoms of hemorrhoids, the first element of service connection has not been established, and the Veteran’s appeal on this issue is denied. See Romanowsky, 26 Vet. App. at 293; Brammer, 3 Vet. App. at 225; 38 C.F.R. § 3.303(a). 8. Entitlement to service connection for a bilateral knee condition is denied. As noted above, the Board reopened the Veteran’s claim for his left knee, so it now will evaluate that claim together with his right knee. The Veteran has claimed entitlement to service connection for bilateral knee arthritis. See July 6, 2018, VA Form 21-526EZ. Recall that pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders, 886 F.3d at 1363. Various entries in the VAMC records note that the Veteran has complained of bilateral knee pain with occasional stiffness, popping, and buckling. While the Veteran certainly is competent to report these subjective symptoms in his knees, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), they do not rise to the level of objective evidence that shows functional impairment that has resulted in a decrease of earning capacity. The Veteran himself does not allege that his knee pain impairs him from working, and the medical evidence of record also does not show such objective indications. In pertinent part, a June 2017 SSA decision noted that the Veteran is disabled form the following conditions: left shoulder, lumbar spine, cervical spine, radiculopathy, chronic pain disorder, diabetes, hypertension, and psychiatric conditions. That determination did not note any condition of the knees, nor did it specifically list where the Veteran experiences “chronic pain.” The Board finds that the Veteran’s subjective complaints of bilateral knee pain do not qualify as a disability. Thus, the first element of service connection has not been established, and the Veteran’s appeal on these issues must be denied. See Romanowsky, 26 Vet. App. at 293; Brammer, 3 Vet. App. at 225; 38 C.F.R. § 3.303(a). 9. Entitlement to service connection for bilateral hearing loss is denied. For VA purposes, service connection for impaired hearing shall only be established when hearing status, as determined by audiometric testing, meets specified pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz). Hensley v. Brown, 5 Vet. App. 155, 158 (1993). Impaired hearing will be considered to be a “disability” when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. For certain chronic diseases, including organic diseases of the nervous system (which include hearing loss and tinnitus), a presumption of service connection arises if the disease is manifested to a degree of ten percent within one year following discharge from service. When a chronic disease is not shown to have manifested to a compensable degree within one year after service, there is required, under 38 C.F.R. § 3.303(b), a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258, 264–65 (2015); 38 C.F.R. § 3.303(b), 3.307(a)(3), 3.309(a). STRs do not contain complaints of, treatment for, or diagnosis of hearing loss. The Veteran’s March 2000 separation examination revealed the following puretone threshold results: Hertz (HZ) 500 1000 2000 3000 4000 Right Ear 5 15 25 10 20 Left Ear 10 10 20 15 10 The Veteran’s DD-214s show that he served as a Material Storage and Handling Specialist, as well as an Automated Logistical Specialist. An August 2018 notification shows that the Veteran did not appear for his scheduled audiological examination. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or (c) of this section as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. For purposes of this section, the terms “examination” and “reexamination” include periods of hospital observation when required by VA. 38 C.F.R. § 3.655(a). When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. Id. at (b). The Veteran failed to report for his examination and, to this day, has failed to articulate good cause why he failed to report. On this point, the regulations are clear: where the Veteran’s claim is an original one, as here, and he fails to report for an examination without good cause, his claim will be rated based upon the evidence of record. See id. Because there is no evidence within the claims file to demonstrate that the Veteran otherwise meets the definition of hearing loss for VA compensation purposes, the first element of service connection has not been established, and the Board need go no further with its analysis. See Romanowsky, 26 Vet. App. at 293; Brammer, 3 Vet. App. at 225; 38 C.F.R. § 3.303(a). 10. Entitlement to service connection for tinnitus is denied. STRs do not contain complaints of, treatment for, or diagnosis of tinnitus during service. The March 2000 separation examination noted normal ears upon clinical evaluation. As with the Veteran’s bilateral hearing loss claim, the Veteran did not report for his scheduled audiological examination. Thus, this claim must be adjudicated based on the evidence of record. See 38 C.F.R. § 3.655(a)–(b). Unlike hearing loss, tinnitus does not require a formal diagnosis that meets certain criteria in the rating schedule. Instead, because it is a condition capable of lay observation, diagnosis can come from the Veteran himself. See Layno, 6 Vet. App. at 469. Like with hemorrhoids, the Veteran only has claimed tinnitus without providing any other details, i.e. that he experiences ringing in his ears. Nevertheless, because tinnitus is unique in that it has only one diagnosable symptom—ringing in the ears—the Board will assume that the Veteran experiences such symptoms, satisfying the first element of service connection. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). The record does not disclose that the Veteran was diagnosed, or even complained of, tinnitus within a year after separation from service. In that case, the application of presumptive service connection for a chronic condition is not applicable. See 38 C.F.R. § 3.307(a)(3), 3.309(a). The record also does not contain evidence that the Veteran has experienced ringing in his ears since service into the present. Thus, the application of presumptive service connection on the basis of continuity of symptomatology is not applicable in this case. See 38 C.F.R. § 3.303(b). Turning to the second element of service connection, the Board finds that the evidence of record is insufficient. The record does not disclose, and the Veteran does not argue, that he was exposed to hazardous noise exposure during service. The Veteran’s two occupations during service were material storage and handling specialist and automated logistical specialist. Neither of these occupations leads the Board to conclude that the Veteran would have had hazardous noise exposure. Thus, the Board does not find that the second element of service connection has been established. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). Even granting the assumption that the Veteran was exposed to some sort of hazardous noise during service, satisfying the second element of service connection, the Veteran’s claim still would fail. Because the Veteran failed to appear for his scheduled examination, he has forgone his opportunity for VA to provide him any sort of medical opinion. Thus, it falls to the Veteran to supply the Board with the necessary medical opinion linking any potential in-service event to his current condition. Because the Veteran has failed to do so, his claim also would be denied for failure to satisfy the third element of service connection. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). 11. Entitlement to service connection for GERD is denied. STRs do not show complaints of, treatment for, or diagnosis of GERD. The post-service VAMC records show that the Veteran currently is treated, and receives medication, for GERD. Thus, the first element of service connection has been established. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). Like with so many of these claims, however, the evidence fails to show that the Veteran experienced any in-service symptomatology, and he does not describe any. The STRs show that, upon separation, the examiner noted a normal abdomen, anus, and rectum. With no evidence of any in-service event or injury, the second element of service connection has not been established. Thus, the Veteran’s appeal on this issue is denied. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). 12. Entitlement to service connection for PTSD is denied. While reopening of this claim is warranted, the Board finds that it otherwise must be denied on the merits. To establish entitlement to service connection for PTSD, there must be: (1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a), which requires a diagnosis in accordance with the Diagnostic and Statistical Manual, Fifth Edition (DSM-5); (2) credible supporting evidence that the claimed, in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). With respect to the second element, where the claimed stressor is unrelated to combat, lay testimony alone generally is not sufficient to establish that an in-service stressor occurred; it must be corroborated by credible supporting, evidence. Cohen v. Brown, 10 Vet. App. 128, 142 (1997). Lay testimony alone may be sufficient where (1) a veteran was diagnosed with PTSD during service with a stressor related to that service; (2) a veteran qualifies as a combat veteran under 38 U.S.C. § 1154 with a stressor related to that service; (3) there exists a stressor related to fear of hostile military or terrorist activity; and (4) where the veteran was a prisoner of war under 38 C.F.R. § 3.1(y) with a stressor related to that prisoner-of-war experience. 38 C.F.R. § 3.304(f)(1)–(4). As noted above, the VAMC records verify that the Veteran currently is treated for PTSD, so the first element of service connection is established. See 38 C.F.R. § 3.304(f). With respect to the second element, the evidence of record is insufficient. The Veteran has not provided any additional details to his previously claimed stressor of witnessing his friend die while stationed in Iraq, and VA already has determined that the Veteran failed to submit sufficient detail so as to permit VA to conduct any meaningful research on the matter. See August 7, 2008, VA Memorandum. Thus, there is nothing more to do with that allegation. Nevertheless, the Veteran asserts a new stressor on appeal: that he tried to assist someone in a domestic violence incident. While the credibility of evidence generally is presumed when VA considers whether to reopen a previously denied claim, see Justus, 3 Vet. App. at 513, that presumption falls away once the claim has been reopened. Thus, while the Veteran’s statement regarding a domestic violence incident is enough to reopen, its credibility now is subject to the standards imposed by 38 C.F.R. § 3.304(f). See Duran v. Brown, 7 Vet. App. 216, 220–21 (1994) (“Moreover, any presumption of credibility required by Justus . . . is inapplicable during the second step when the claim is adjudicated de novo by evaluating both the weight and credibility of all the evidence of record.”). Evaluating the Veteran’s statement under the lens of 38 C.F.R. § 3.304(f) shows that it is not sufficient. The Veteran has not claimed that he was diagnosed with PTSD during service, is a combat Veteran, was subject to the fear of hostile military or terrorist activity, or was a prisoner of war under 38 C.F.R. § 3.1(y), nor does the evidence of record suggest that any of these apply. Thus, lay testimony alone cannot serve as the basis to establish the in-service element for the Veteran’s PTSD claim and, instead, must be corroborated by credible, supporting evidence. See Cohen, 10 Vet. App. at 142; 38 C.F.R. § 3.304(f)(1)–(4). The duty to assist is neither a one-way street, Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), nor “a license for a ‘fishing expedition’ to determine if there might be some unspecified information which could possibly support a claim.” Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) (emphases in original). The Veteran has provided the Board with a one-sentence statement: that he attempted to assist someone in a domestic violence incident. There is no credible, supporting evidence in the record to substantiate that claim, nor has the Veteran provided any additional details that could permit VA to conduct any meaningful research on the matter. The Veteran does not provide names of individuals involved, date(s) of the incident, or location. Thus, the Veteran’s allegation is not enough to satisfy the second element of service connection for PTSD, so his claim on this issue is denied. See 38 C.F.R. § 3.304(f). Earlier Effective Date Unless specifically provided otherwise in this chapter, the effective date of an award based on an initial claim, or a supplemental claim, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). A claim means a written or electronic communication requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit under the laws administered by VA submitted on an application form prescribed by the Secretary. 38 C.F.R. § 3.1(p). A supplemental claim is defined as “a claim for benefits under laws administered by the Secretary filed by a claimant who had previously filed a claim for the same or similar benefits on the same or similar basis.” 38 U.S.C. § 101(36). A complete claim is one on an application form prescribed by the Secretary that (1) provides the name of the claimant, relationship to the veteran (if applicable), and sufficient information for VA to verify the claimed service (if applicable); (2) is signed by the claimant or representative; (3) identifies the benefit sought; and (4) lists a description of the symptoms or medical conditions on which the benefit is based. 38 C.F.R. § 3.160(a). For service connection, the effective date shall be the day following separation from active service or date entitlement arose if a claim is received within one year after separation from service, 38 U.S.C. § 5110(b)(1); otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). Separation from service means separation under conditions other than dishonorable from continuous active service which extended from the date the disability was incurred or aggravated. Id. On his July 6, 2018, VA Form 21-526EZ, the Veteran claimed entitlement to service connection for insomnia. In the October 2018 decision on appeal, VA correctly noted its duty to expand the Veteran’s claim for insomnia into any mental disability that may be reasonably encompassed. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Veteran consequently was awarded service connection for depressive disorder; he was granted a 70 percent disability rating effective July 6, 2018—the day he filed his claim for PTSD. An analysis of the facts shows that the Veteran was awarded an effective date more generous than that to which he is entitled. The Veteran separated from his second period of active duty service in March 2000. His claim was not received within one year form the date of separation, so he is not entitled to an effective date the day following separation from active duty. See 38 U.S.C. § 5110(b)(1). Thus, the default rule applies—the latter between filing and the date entitlement arose. In August 2018, VA afforded the Veteran a psychiatric examination, which revealed that his depressive disorder was related to service. Thus, it is not until that date that the necessary elements for service connection had been established. Nevertheless, VA generously awarded the Veteran an effective date of July 6, 2018—the day he filed his claim. There are no other claims throughout the record previously unaddressed by VA, so his appeal on this issue is denied. See 38 C.F.R. § 3.400(b)(2)(i). Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Fenderson v. West, 12 Vet. App. 119, 126 (1999). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. For psychiatric disabilities, a 100 percent disability rating contemplates total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, due to such symptoms as: suicidal ideation; obsessional rituals, which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such an unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant a particular rating, but are not meant to be exhaustive, and the Board need not find all, or even some, of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442–43 (2002). If the evidence shows that a veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a specific rating, the appropriate, equivalent rating will be assigned. Id. at 443. The rating code requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment at a level consistent with the assigned rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed. Cir. 2013). VA is precluded from differentiating between the symptoms of the Veteran’s service-connected PTSD and those of her other mental disorders in the absence of clinical evidence that clearly shows such a distinction. See Mittleider v. West, 11 Vet. Ap. 181, 182 (1998). Furthermore, because all psychiatric disorders, with the exception of eating disorders, are evaluated under the General Rating Formula for Mental Disorders, a single evaluation will be assigned that encompasses all of the Veteran’s overlapping psychiatric symptoms, however diagnosed. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009). An August 2018 VA examination report noted mental examination of the Veteran and review of the claims file and recited the Veteran’s complaints and medical history. The examiner diagnosed depressive disorder due to chronic pain syndrome with major depressive-like episodes. The Veteran was diagnosed with occupational and social impairment with deficiencies in most areas. With respect to social functioning, the examiner noted that the Veteran has an estranged relationship with his current wife, has one friend, endorsed significant peer relational problems, and denied regular engagement in social activities outside of the work setting. The report simply indicates that the Veteran does not work. Noted symptoms were depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; and suicidal ideation. In November 2020, the Veteran submitted a September 2020 disability benefits questionnaire (DBQ) completed by Dr. K.G. Dr. G. diagnosed depressive disorder due to chronic pain and alcohol use disorder and noted occupational and social impairment with deficiencies in most areas. Dr. G. noted that the Veteran is close to his mother and youngest sister. At this point, the Veteran’s wife was deceased. The Veteran has not worked since January 2015. Noted symptoms were depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss; impairment of short and long term memory; flattened affect; speech intermittently illogical, obscure, or irrelevant; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; persistent delusions or hallucinations; and persistent danger of hurting self or others. In her attached Psychiatric Symptom Statement, Dr. G., in pertinent part, noted that the Veteran denied delusions, but endorsed vague, visual hallucinations (someone coming up behind him but with no one there). Since the loss of his wife (February 2020) the Veteran has had daily suicidal ideation and lost to his daughter custody of his eight-year-old son. The COVID-19 pandemic has limited the Veteran’s access to mental health treatment, and he often turns to alcohol as a coping mechanism. The VAMC records associated with the claims file also document the continued care and treatment the Veteran receives for his psychiatric condition. Based on the pertinent evidence, the Board does not find that the Veteran is entitled to a schedular rating in excess 70 percent for his psychiatric condition. As noted above, a 100 percent schedular rating requires total social and occupational impairment. The examinations above indicate that, while severely diminished, the Veteran does have some social interaction. Between Drs. G. and B., it was established that the Veteran has one friend and has a good relationship with his mother and youngest sister. By these assessments, it cannot be said that the Veteran experiences total social impairment due to his psychiatric condition. There is no doubt that the Veteran’s social relationships and activities indeed have suffered as a result of his condition, but that does not mean that they are nonexistent. Thus, because the Board finds that the Veteran does not experience total social impairment, it cannot be said that his psychiatric condition causes both total social and occupational impairment. Therefore, the Veteran’s appeal on this claim is denied. See 38 C.F.R. § 4.130, DC 9434. TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. A finding of total disability is appropriate when there is present any impairment of mind or body, which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340(a)(1), 4.15, 4.16. A claim for a total disability rating based upon individual unemployability presupposes that the rating for the service-connected disability is less than 100 percent, and only asks for TDIU because of subjective factors that the objective rating does not consider. Vettese v. Brown, 7 Vet. App. 31, 34–35 (1994). Where the schedular rating is less than total, a total disability rating for compensation may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, that disability shall be ratable at 60 percent or more. If there are two or more disabilities, then there shall be at least one disability ratable at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16(a). The term substantially gainful occupation is not specifically defined for purposes of the regulations governing TDIU. Marginal employment, however, is not considered substantially gainful employment. Marginal employment includes situations in which an individual’s annual income does not exceed the poverty threshold for one person. Employment may be marginal even when the individual’s earned income exceeds the poverty threshold if such individual is employed in a protected environment such as a family business or sheltered workshop. 38 C.F.R. § 4.16(a). In evaluating a veteran’s employability, consideration may be given to his level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. As of July 6, 2018, the Veteran has met the schedular criteria for a TDIU rating: he had a single disability rated at least 70 percent disabling for the service-connected psychiatric disability; and a 20 percent rating for service-connected left shoulder disability. Because the Board herein has denied entitlement to an effective date earlier than July 6, 2018, for the award of service connection for depressive disorder, and because this TDIU claim is part and parcel of the Veteran’s increased rating claim for his psychiatric condition, see Rice v. Shinseki, 22 Vet. App. 447, 454 (2009), the Board may consider TDIU only as early as that date. When the Veteran filed his July 2018 claim for TDIU (VA Form 21-8940), he indicated that he has not worked full time since December 2015, when he was working as a clerk earning $1,500 per month. The Veteran noted that he completed two years of college but otherwise has had no education or training before or after he became too disabled to work. For the reasons set forth below, the Board finds that TDIU is warranted. In addition to the DBQ, Dr. G. also submitted a Residual Functional Capacity Evaluation form related ot the Veteran’s mental condition. Dr. G. indicated that, due to solely to his psychiatric condition, the Veteran would (1) miss three or more days of work per month, (2) need to leave work early three or more days per month, (3) more than three days per month not stay focused for at least seven hours of an eight-hour workday, and (4), if subject to normal criticism, more than once per month would respond in angry manner without becoming violent and frequently decompensate when subject to that type of pressure. Dr. G. ultimately opined that the Veteran’s depressive disorder is severe enough to prevent him from sustaining gainful employment. A September 2020 opinion (submitted in November 2020) by Dr. B. indicates that the Veteran’s mental condition and left shoulder condition prevents him from achieving gainful employment. The Board ultimately finds that the Veteran’s service-connected disabilities prevent him from securing or following a substantially gainful occupation. The medical opinions from Drs. G. and B. both are competent and credible medical evidence that is uncontradicted by the other competent and credible lay and medical evidence of record. Thus, the Board affords them considerable probative value on appeal. Without any evidence to the contrary, the Board finds that the Veteran’s service-connected depressive disorder precludes securing or following a substantially gainful occupation and will award the Veteran TDIU beginning July 6, 2018. Automobile and Adaptive Equipment Financial assistance may be provided to an “eligible person” in acquiring an automobile or other conveyance and adaptive equipment, or adaptive equipment only. 38 U.S.C. § 3902(a)(b). Eligibility for assistance to purchase a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis; or (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 U.S.C. § 3901; 38 C.F.R. § 3.808. The record does not disclose that the Veteran has any of the above-mentioned conditions that would warrant an award of an automobile or special adaptive equipment. As such, his appeal on this issue is denied. See 38 U.S.C. § 3901; 38 C.F.R. § 3.808. REASONS FOR REMAND 12. Whether new and material evidence has been received to reopen the claim for entitlement to service connection for a low back disability, to include as secondary to service-connected left shoulder disability, is remanded. The Veteran’s claim for entitlement to service connection for his low back most recently was denied via a September 2015 Statement of the Case (SOC). The Veteran failed to perfect his appeal to the Board, so that appeals was closed out as final. See 38 C.F.R. §§ 19.22, 19.32. While VA acknowledged that the Veteran had in-service complaints of low back pain, previous VA examination failed to show that there was any relation between the Veteran’s current condition and his in-service complaints of pain. The Veteran refiled for his low back condition, alleging that it was secondary to his service-connected left shoulder disability. See May 12, 2016, VA Form 21-526EZ. In December 2017, VA secured a medical opinion to assess the Veteran’s allegations. That opinion stated: Veteran’s back condition is less likely tha[n] not(less than 50 percent probability) proximately due to his shoulder condition. Veteran STRS indicate that his left shoulder condition is separation injury and diagnosis and has been treated individually since 1999. Veteran had first surgical procedure on left shoulder on left shoulder in 1999 after an injury in Bosnia. MRI in 07/2004 indicated post surgical changes and degenerative changes of the [acromioclavicular] joint. He had arthroscopic debridement of the shoulder 2 months later in 09/2004 and open rotator cuff repair. Veteran also worked for G.E and work duties entailed lifting materials during 2005 in which he reported injury to left shoulder. X-ray of left shoulder in 2009 indicated deformity of distal clavicle and widening of ACJ. He was diagnosed with a Grade II AC separation in 11/2011 and probable supraspinatus tear in 01/2014. Lumbar degenerative disc disease is a part of aging. Veteran STRs does not indicate injury, illness or trauma to back and left shoulder at the same time. A nexus has not been establish[ed]. Necessary and or more documentation to be submitted to substantiate claim. The claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the claimant’s service connected condition. When the Veteran refiled, his mere allegation that his back condition was secondary to his service-connected left shoulder, in and of itself, was not enough to warrant reopening of his claim. See Boggs, 520 F.3d at 1336–37. Nevertheless, VA, own its own accord, decided to obtain a medical opinion on the matter. When VA made that choice, it triggered its obligations under its duty to assist to ensure that it obtained an adequate medical opinion. A medical opinion is adequate when it is based upon consideration of the veteran’s prior medical history and examinations and also describes the disability in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). To qualify as adequate, a medical examination and opinion provided for the purposes of assessing secondary service connection must address both whether the claimed disability was proximately caused by some service-connected disability and whether the claimed disability was aggravated (chronically worsened) by some service-connected disability. El-Amin v. Shinseki, 26 Vet. App. 136, 139–41 (2012). The Board concedes that, while the obtained opinion provides a negative nexus as to proximate causation, it does not address aggravation. Because VA has failed its duty to assist, the Board cannot evaluate whether that opinion could have produced new and material evidence so as to warrant reopening of the Veteran’s claim. Thus, remand is required for VA to obtain an addendum opinion. See 38 C.F.R. § 20.904(a); cf. Ivey v. Derwinski, 2 Vet. App. 320, 322–23 (1992) (holding that a veteran placing VA on notice of medical records not associated with the claims file, while not necessarily new and material evidence, triggers VA’s duty to assist before VA can determine whether reopening is warranted). 13. Entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder disability and/or to bilateral knee disabilities, is remanded. While the RO has characterized this issue as one to reopen, requiring new and material evidence, that determination is incorrect. The Veteran filed his claim for service connection for his neck disability, secondary to his service-connected left shoulder, in May 2016. That claim was denied in a March 2018 rating decision. Within his one-year appellate period, the Veteran again filed in May 2018. That claim never was addressed by the RO, and the Veteran filed again in July 2018; that claim was denied in October 2018. The Veteran appealed that determination via a Notice of Disagreement (NOD) in February 2019, placing it in its current appellate status. Because the Veteran’s February 2019 NOD was filed within one-year from the March 2018 rating decision, this claim is an original one, and not one that requires reopening with new and material evidence under 38 C.F.R. § 3.156(a). An October 2019 SOC acknowledged that the Veteran’s STRs show a chronic cervical spine condition. Despite that acknowledgment, VA secured, in December 2017, only an opinion for secondary service connection concerning the Veteran’s left shoulder. The examiner provided the following opinion: Veteran’s neck condition is less likely tha[n] not(less than 50 percent probability) proximately due to his shoulder condition. Veteran STRS indicate that his left shoulder condition is separation injury and diagnosis and has been treated individually since 1999. Veteran had first surgical procedure on left shoulder on left shoulder in 1999 after an injury in Bosnia. MRI in 07/2004 indicated post surgical changes and degenerative changes of the [acromioclavicular] joint. He had arthroscopic debridement of the shoulder 2 months later in 09/2004 and open rotator cuff repair. Veteran also worked for G.E and work duties entailed lifting materials during 2005 in which he reported injury to left shoulder. X-ray of left shoulder in 2009 indicated deformity of distal clavicle and widening of ACJ. He was diagnosed with a Grade II AC separation in 11/2011 and probable supraspinatus tear in 01/2014. Cervical degenerative disc disease is a part of aging. Veteran STRs does not indicate injury, illness or trauma to neck and left shoulder at the same time. A nexus has not been establish[ed]. Necessary and or more documentation to be submitted to substantiate claim. The claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the claimant’s service connected condition. To start, despite VA’s concession that the Veteran had a chronic neck condition during service, it never obtained an opinion for direct service connection. Thus, VA has failed its duty to assist by not obtaining a direct opinion, which it must do on remand. Additionally, the secondary opinion itself is inadequate. As noted, a medical opinion addressing secondary service connection also must discuss aggravation. Because the December 2017 examiner does not do so, the opinion is inadequate and requires correction on remand. See El-Amin, 26 Vet. App. at 139–41; 38 C.F.R. § 20.904(a). Lastly, the Veteran submitted, in May 2018, medical opinions relating his neck condition to both service and his left shoulder condition. In May 2017, Dr. T.G. stated that “it is as likely as not that [the Veteran’s] military service activities as well as his shoulder issue contributed to, or aggravated his current neck condition.” Dr. D.W., in an April 2018 form, states that the shoulder pain is related to his neck condition. Both private opinions fall short of what is required to grant service connection as they merely state conclusory opinions with no supporting rationale. Thus, on remand, a VA examiner must respond to these opinions as well. While Counsel has alleged that the Veteran’s knee disabilities have caused his neck disability, see July 6, 2018, VA Form 21-526EZ, the Board herein has denied service connection for the bilateral knees, so it will not require VA to obtain an opinion on that point. 14. Entitlement to service connection for a right shoulder disability, to include as secondary to service-connected left shoulder disability, is remanded. This claim similarly must be remanded for an inadequate secondary opinion. In May 2015, VA received the following medical opinion: THE DIAGNOSED DEGENERATIVE ARTHRITIS CONDITION OF THE RIGHT SHOULDER IS MEDICALLY UNRELATED TO HIS COEXISTING LEFT SHOULDER CONDITION. DYSFUNCTION OF ONE JOINT IS NOT A RISK FACTOR FOR THE DEVELOPMENT OF ARTHRITIS IN THE CONTRALATERAL JOINT. This opinion is conclusory at best. It does not describe for the Board in sufficient detail why the two conditions are unrelated, nor does it differentiate between proximate cause or aggravation. As such, VA is required to secure an adequate opinion on remand. See El-Amin, 26 Vet. App. at 139–41; 38 C.F.R. § 20.904(a). 15. Entitlement to service connection for radiculopathy of the bilateral lower extremities is remanded. The claims file contains numerous records relating to the Veteran’s low back disability. Private treatment records from January and April 2017 show that the Veteran’s radiculopathy of his bilateral lower extremities is connected to his low back. VA regulations state that, when rating conditions of the spine, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are rated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code 5235–5242 at Note (1). Thus, it is premature to adjudicate the issues of bilateral radiculopathy until the Board can determine whether service connection for the low back is warranted. These claims, therefore, inextricably are intertwined to the Veteran’s low back claim, requiring remand. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation); 38 C.F.R. § 20.904(a). The matters are REMANDED for the following action: 1. Obtain any ongoing VA treatment records. Should they exist, associate them with the claims file. 2. Obtain an addendum to the December 2017 opinion for the Veteran’s low back disability. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s service-connected left shoulder disability (i) proximately caused or (ii) aggravated beyond natural progression his low back disability? 3. Obtain an addendum to the December 2017 opinion for the Veteran’s neck disability. The addendum shall answer the following: (a.) Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s neck disability occurred in, or is the result of, his period of active duty service? In answering this question, the examiner must discuss Dr. T.G.’s opinion that the Veteran’s neck disability is related to service. (b.) Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s service-connected left shoulder disability (i) proximately caused or (ii) aggravated beyond natural progression his neck disability? In answering this question, the examiner must discuss Dr. T.G.’s and Dr. D.W.’s opinions stating as such. 4. Obtain an addendum to the May 2015 opinion for the Veteran’s right shoulder disability. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s service-connected left shoulder disability (i) proximately caused or (ii) aggravated beyond natural progression his right shoulder disability? Note: The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. A detailed rationale supporting the examiner’s opinions must be provided. The lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. 5. Conduct any other development deemed necessary and then readjudicate the Veteran’s claims. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or United States Court of Appeals for Veterans Claims must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Trevor T. Bernard, 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.