Citation Nr: 21007628 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-07 655 DATE: February 10, 2021 ORDER Service connection for a respiratory disorder is denied. Service connection for obstructive sleep apnea (OSA) is denied. An effective date of October 17, 2007, but no earlier, for the award of service connection for essential tremor is granted. REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) and depressive disorder, not otherwise specified (NOS), is remanded. Entitlement to an initial compensable rating for essential tremor is remanded. FINDINGS OF FACT 1. A respiratory disorder is not shown to be causally or etiologically related to any disease, injury, or incident during the Veteran’s first period of active duty, and clear and unmistakable evidence establishes that asthma pre-existed his second period of active duty and was not aggravated beyond the natural progression therein. 2. OSA is not shown to be causally or etiologically related to any disease, injury, or incident during service, and is not caused or aggravated by service-connected PTSD with depressive disorder, NOS. 3. On October 17, 2007, VA received the Veteran’s original informal claim for service connection for essential tremor. CONCLUSIONS OF LAW 1. The criteria for service connection for a respiratory disorder, have not been met. 38 U.S.C. §§ 1110, 1111, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 2. The criteria for service connection for OSA have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for an effective date of October 17, 2007, but no earlier, for the award of service connection for essential tremor have been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1969 to June 1971 and from November 1990 to May 1991, which included tours in the Republic of Vietnam and Southwest Asia, respectively. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon and Navy Achievement Medal with Combat V. This matter comes before the Board of Veterans’ Appeal (Board) on appeal from ratings decisions issued in April 2012, December 2013, and November 2018 by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2017, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In September 2018, the Board awarded service connection for essential tremor, and remanded the Veteran’s claims for service connection for a respiratory disorder and OSA, and an increased rating for his PTSD and depressive disorder, NOS, for additional development. In a November 2018 rating decision, the Agency of Original Jurisdiction (AOJ) effectuated the Board’s grant of service connection for essential tremor with a noncompensable rating, effective January 30, 2012. Thereafter, the Veteran perfected an appeal as to the propriety of the initially assigned rating and effective date, but did not request a hearing on such matters. Further, the remanded claims now return for further appellate review. The Board notes that, since the issuance of the March 2020 statement of the case and June 2020 supplemental statement of the case, additional evidence consisting of updated VA treatment records and unrelated VA examinations have been received. However, as such evidence does not pertain to the issues on appeal or contain findings duplicative to those previously considered by the AOJ, such is irrelevant and there is no prejudice to the Veteran in the Board proceeding with a decision at the present time. 38 C.F.R. § 20.1305(c). In August 2020, the Veteran’s attorney requested a copy of the Veteran’s claims file, as well as a 90-day extension in which to review this information and submit further evidence and argument. In August 2020, VA issued a letter granting the information request, indicating that the Veteran’s claims file would be provided via a mailed compact disc (CD). However, per an October 2020 correspondence, the Veteran’s attorney did not receive the CD until October 1, 2020, and accordingly requested a 60-day extension from this date of receipt of the CD. As the requested extension period has now expired, the case is now ready for appellate review. Service Connection Claims Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the veteran’s entrance examination report, this presumption of soundness operates to shield the veteran from any finding that the unnoted disease or injury preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48 (2012); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991); 38 C.F.R. § 3.304 (b). Such presumption is only rebutted where the evidence clearly and unmistakably shows that the veteran’s disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby, 1 Vet. App. at 227; VAOPGCPREC 3-2003 (July 16, 2003). The two parts of this rebuttal standard are referred to as the “preexistence prong” and the “aggravation prong.” Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). To satisfy this second-prong requirement for rebutting the presumption of soundness, the government must show by clear and unmistakable evidence either that there was no increase in disability during service or that any increase in disability was “due to the natural progression” of the condition. Joyce v. Nicholson, 443 F.3d 845, 847 (Fed. Cir. 2006). Under 38 U.S.C. § 1153, a preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. The occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306 (a). Evidence of the veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder has not been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1996). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a respiratory disorder, to include chronic obstructive pulmonary disease (COPD) and asthma. As a threshold matter, the evidence must reflect a current disability; otherwise, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In September 2018, the Board observed that the Veteran’s post-service treatment records reflected a diagnosis of mild asthma, but did not show a diagnosis of COPD. However, as Dr. P.Y, a chiropractor, noted a diagnosis of COPD/bronchial asthma in May 2013, the Board remanded the case in order to obtain clarification regarding the nature of the Veteran’s current respiratory disorder. Thereafter, the Veteran underwent a VA respiratory examination in October 2019, at which time he was diagnosed only with asthma. As explained by the VA examiner, the results of pulmonary functions tests (PFTs) have produced results supporting only a diagnosis of asthma and not COPD, as post-bronchodilator testing was completely normalized, which is not possible with COPD. The examiner further concluded that the record failed to reflect any clinical data supporting a diagnosis of COPD, and as such, the examiner was unclear on what basis COPD had been diagnosed by other clinicians. Indeed, the VA examiner’s conclusion is consistent with a September 2018 computerized topography (CT) scan of the Veteran’s lungs, which were interpreted to reveal no evidence of interstitial lung disease, but suggested evidence of reactive airways disease (a term used by clinicians when asthma is suspected, but not confirmed). Consequently, the Board affords greater probative weight to the October 2019 VA examiner’s conclusion regarding the nature of the Veteran’s respiratory disorder, which was supported by objective diagnostic tests, than Dr. P.Y., a chiropractor who has no expertise in respiratory disorders, and finds that he does not have a diagnosis of COPD. As to the etiology of the Veteran’s asthma, he does not assert, and the evidence does not suggest, that such disorder is related to his first period of service from August 1969 to June 1971. In this regard, his service treatment records from such period of service are negative for any complaints, treatment, or diagnosis referable to asthma. Rather, such only reflect upper respiratory complaints related to tonsillitis, the flu, upper respiratory tract infection, and a cold, which resolved following treatment. Accordingly, there is no basis to award service connection for asthma based on such period of service. Rather, the Veteran contends that he currently his asthma is related to his exposure to environmental hazards consistent with his service in Southwest Asia, to include burn pits, oil fires, sand/dust storm, and diesel fuel and exhaust, during his second period of service. In this regard, records from the Veteran’s National Guard service and second period of active duty from November 1990 to May 1991 suggest that his asthma may have had its onset during the interim between his two periods of active duty. In this regard, a May 1986 enlistment examination for the National Guard, as well as service treatment records for his second period of active duty, reflect the Veteran’s report of hay fever and allergies. However, the Veteran has not asserted and the evidence of record does not suggest that his asthma, a disease, had its onset in or was aggravated during a period of active duty for training between his two periods of active duty. Nevertheless, given the chronology suggesting the onset of the Veteran’s asthma between his two periods of active duty and his report that such disorder is related to exposure to environmental hazards coincident with his service in Southwest Asia, the Board remanded the case in September 2018 so as to obtain a VA medical opinion addressing whether the Veteran’s asthma did indeed preexist his second period of active service and, if so, whether such was aggravated therein. In this regard, the Board acknowledges the Veteran’s general assertions that his breathing difficulties increased in severity during his service in Southwest Asia, and notes that he is competent, as a lay person with no known or reported medical expertise, to report experiencing an increase in his respiratory symptomatology during such period of service. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). However, as a determination as to whether his respiratory disorder may be clinically attributed to any aspect of his military service, to include exposure to environmental hazards in Southwest Asia, is a complex medical matter, requiring related expertise, competent medical evidence is needed to decide the claim. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (holding that a lay person is not considered competent to testify regarding medically complex issues). In an October 2019 opinion, the VA examiner who conducted the Veteran’s October 2019 VA respiratory examination opined that his asthma clearly and unmistakably existed prior to his second period of active service from November 1990 to May 1991. In support of this opinion, she noted that, at the time of the May 1986 National Guard examination, the Veteran reported experiencing hay fever, but denied asthma, shortness of breath, chronic cough, and frequent trouble sleeping, and comments noted “has hay fever—no asthma.” However, the examiner indicated that the Veteran’s current medications were noted to include “Beclomethasone—allergy,” which is a steroidal inhaler used to treat asthma. She also noted that relevant medical literature reflected that allergen exposures are an asthma trigger, and concluded that the Veteran’s May 1986 National Guard examination supported a finding that he had allergen sensitivity causing hay fever as well as bronchial reactivity/asthma, which was treated with the aforementioned steroidal inhaler. The examiner further observed that the Veteran’s April 1991 separation examination from active duty reflected that, while he denied chronic cough, asthma, and frequent trouble sleeping, he reported shortness of breath and it was noted that he continued to use Beclomethasone “for allergy.” In this regard, she indicated that such further supported a finding that the Veteran used such steroidal inhaler for shortness of breath related to allergen exposure, which, in turn, caused asthma symptoms. Accordingly, the examiner concluded that there was clear and unmistakable evidence that the Veteran had allergy-triggered asthma prior to his second period of active service. Furthermore, while the Veteran reported experiencing an increased in his respiratory symptomatology during his second period of active duty, the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis, supra; 38 C.F.R. § 3.306(a). Similarly, an exacerbation of symptoms during service does not constitute evidence of aggravation. Green, supra. Furthermore, the October 2019 VA examiner found that there was clear and unmistakable evidence that the Veteran's preexisting asthma did not undergo an increase in the underlying pathology during service, i.e., was not aggravated during service. In this regard, she observed that the Veteran’s service treatment records from his second period of active duty did not show any visits for asthma symptoms, and the treatment ascribed to such disorder as described in the May 1986 National Guard examination was identical to such described in his April 1991 separation examination. As such, the examiner determined that there is no clinical indication of a worsening of asthma symptoms during service and, thus, such preexisting disorder was clearly and unmistakably did not aggravated therein. The Board affords great probative weight to the October 2019 VA examiner’s opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). As to the other medical opinions of record, as noted by the Board in September 2019, they are legally inadequate and therefore cannot serve as a basis for awarding service connection. Specifically, Dr. P.Y., a chiropractor, concluded in May 2013 that the Veteran developed COPD/bronchial asthma as a result of in-service inhalation of fumes from burn pits and oil fires, but he offered no supporting rationale for this conclusion. Similarly, in an April 2017 VA treatment record, the Veteran’s treatment provider noted a diagnosis of mild asthma, and stated that his environmental exposure likely has contributed to his lung condition, but provided no rationale for his conclusion and was unable to determine what percent/to what degree the Veteran’s time in the Gulf War would be causative of his condition. Furthermore, neither medical opinion addresses whether the Veteran’s respiratory existed his second period of active service or utilizes the correct legal standard for such a determination. Accordingly, these medical opinions are afforded no probative weight. In sum, the Board finds that a respiratory disorder is not shown to be causally or etiologically related to any disease, injury, or incident during the Veteran’s first period of active duty, and clear and unmistakable evidence establishes that asthma pre-existed his second period of active duty and was not aggravated beyond the natural progression therein. Consequently, service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for a respiratory disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Entitlement to service connection for OSA, to include as secondary to a respiratory disorder and/or service-connected PTSD and depressive disorder, NOS. The Veteran claims that OSA is related to his combat service in Vietnam, or is caused or aggravated by his respiratory disorder and/or service-connected PTSD and depressive disorder, NOS. As an initial matter, the Board notes that the Veteran a current diagnosis with OSA, as demonstrated by a June 2013 sleep study. Further, while his service treatment records from both periods of service are negative for any complaints, treatment, or diagnosis referable to OSA, the record reflects that the Veteran served in combat in Vietnam. Furthermore, he is service-connected for PTSD with depressive disorder, NOS. Thus, the remaining inquiry is whether the Veteran’s currently diagnosed OSA is related to his combat service, or service-connected psychiatric disability. However, as the Board has denied service connection for a respiratory disorder herein, service connection for OSA as secondary to such disorder is precluded as a matter of law. Thus, such theory of entitlement will not be further addressed. As to the relevant inquiry in this case, in May 2013, Dr. P.Y, a chiropractor, noted a provisional diagnosis of sleep apnea that is more likely than not directly and causally related to the Veteran’s respiratory disorder and his military service. Additionally, a March 2017 Kaiser Permanente treatment record reflects an assessment of OSA and nightmare disorder, and the provider’s statement that medical literature has demonstrated a higher prevalence of OSA in patients with PTSD. However, he observed that there was no consistent evidence regarding causative factors, although there is some speculation that this can be related to the development of obesity due to lack of physical fitness in the setting of psychiatric illness, comorbid substance abuse, or stress of sleep deprivation. In April 2017, the Veteran’s VA treatment provider stated that, while it was acknowledged that untreated sleep apnea (or any sleep disturbance) may worsen PTSD/nightmares and PTSD/nightmares may worsen or interrupt sleep/toleration of sleep apnea treatment, there was no data to support that sleep apnea causes PTSD, or conversely, that PTSD causes sleep apnea. The Veteran also submitted numerous medical treatises suggesting a relationship between PTSD and sleep apnea. As determined in the September 2018 remand, these medical opinions are legally inadequate to decide the Veteran’s claim. In that regard, while Dr. P.Y., a chiropractor, suggested that the Veteran’s OSA is related to his military service, he did not offer a rationale for such opinion. Additionally, while the Veteran’s private and VA treatment providers suggest that there is a link between PTSD and sleep apnea, such statements are couched in speculative terms. Further, the medical treatise evidence submitted by the Veteran is not accompanied by any corresponding clinical evidence specific to him, and do not suggest a generic relationship between his OSA and his service-connected PTSD with a degree of certainty such that, under the facts of this specific case, reflects plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. Furthermore, as the Veteran’s own lay assertions are likewise legally inadequate to decide this claim, as medical expertise is required to decide complex matters such as the relationship between a sleep disorder and service or a service-connected disability, the Board requested a VA etiological opinion, which was rendered in October 2019. See Jandreau, 492 F. 3d 1372. In this regard, after conducting a VA OSA examination, the examiner opined that the Veteran’s OSA was unlikely related to his combat service in the Republic of Vietnam or is caused or aggravated by his service-connected psychiatric disability. Specifically, she opined that the Veteran’s OSA is less likely than not related to his combat service in Vietnam he had a normal examination of his lungs, chest, and neck, and a normal body mass index (BMI) at his June 1971 separation examination (noting that a higher BMI indicates obesity, a primary risk factor of OSA). The VA examiner further noted that the Veteran denied experiencing any trouble sleeping at the time of his May 1986 National Guard examination and April 1991 separation examination. She also observed that, at his October 2019 VA examination, the Veteran indicated that he was unsure when his spouse first noticed apneic episodes, but it was sometime before his June 2013 sleep study, which reflected the initial diagnosis of OSA, and, at his April 2017 Board hearing, he reported that he experienced snoring and apneic episodes approximately five years prior to such sleep study, which placed the onset of OSA symptomatology in approximately 2008, which was many years after his separation in 1971. The VA examiner further opined that it was less likely than not that the Veteran’s OSA was caused by his service-connected psychiatric disability of PTSD and a depressive disorder, NOS. In this regard, she noted that, while there is medical literature noting a higher probability of screening positively on OSA questionnaires in those with PTSD and higher prevalence overall of mental health conditions in this with sleep apnea, the weight of the literature does not support a causal relationship between PTSD and/or depressive disorders and OSA. In this regard, she cites to the April 2017 VA treatment record that noted that there was no data to support that OSA causes PTSD or conversely that PTSD causes OSA. Rather, the VA examiner opined that the Veteran’s OSA is more likely due to his other known risk factors, namely his age, gender, and neck circumference. Likewise, the VA examiner found it less likely than not that the Veteran’s OSA is aggravated by his service-connected psychiatric disability. In support of such opinion, she again observed that, while some medical literature notes that a higher probability of screening positively on OSA questionnaires in this with PTSD and higher prevalence overall of mental health conditions in those with sleep apnea, the weight of the literature does not support an aggravating relationship between PTSD and/or depressive disorders and OSA. The Board affords great probative weight to the October 2019 VA examiner’s opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl, supra. In sum, the Board finds that OSA is not shown to be causally or etiologically related to any disease, injury, or incident during service, and is not caused or aggravated by service-connected PTSD with depressive disorder, NOS. Consequently, service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for OSA. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Earlier Effective Date Claim 3. Entitlement to an effective date prior to January 30, 2012, for the award of service connection for essential tremor. The assignment of an effective date for an award is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on a claim for service connection or for an increase of compensation “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore.” 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date for an award of service connection is the day after separation from service or day entitlement arose, if a claim is received within one year of separation from service, otherwise the date of receipt of claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1(p), 3.151, 3.155; Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999); Lalonde v. West, 12 Vet. App. 377 (1999). Prior to March 24, 2015, any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, was considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). In a statement received by VA on October 17, 2007, the Veteran asserted that he developed an essential tremor soon after his return from Vietnam as a result of anxiety and nervousness. Specifically, he reported that he first noticed a significant left hand tremor (such that he would have difficulty lighting his cigarettes), accompanied by continuous anxiety, upon his return from Vietnam and, over time, his left hand tremor diminished in severity until 2003 or 2004, when he noticed that his left hand tremor had increased in severity and he had developed a right hand tremor. In a November 2007 rating decision, the Veteran was granted service connection for PTSD, but the decision failed to mention the Veteran’s reportedly related hand tremors. On January 30, 2012, the Veteran submitted a statement asserting service connection for bilateral hand tremors as secondary to PTSD, and in an April 2012 rating decision, the RO denied service connection for essential tremor, which Veteran appealed to the Board. In the September 2018 decision, the Board granted service connection for an essential tremor, and in a November 2018 rating decision, the AOJ effectuated this grant effective as of the date of receipt of the January 2012 claim. However, as the record reflects that the Veteran set forth, in detail, that he developed this essential tremor soon after his return from Vietnam as a result of anxiety and nervousness in October 2007, this correspondence can be construed as an informal claim for service connection for such disorder, which remained unaddressed and pending at the time the claim was ultimately granted in the September 2018 Board decision, which was implemented in the November 2018 rating decision. Accordingly, the Board concludes that such correspondence establishes a basis for granting an earlier effective date of October 17, 2007, for the award of service connection for essential tremor. However, the Board finds that an effective date prior to October 17, 2007, for the award of service connection for such disability is not warranted. In this regard, while the AOJ received the Veteran’s original claim for service connection for PTSD on July 12, 2007, such made no mention of tremors. Thus, absent at least a general description of neuropathy of the bilateral upper extremities, such earlier filings may not be construed as a claim for service connection for such disorders. Sellers v. Wilkie, 965 F.3d 1328 (Fed. Cir. 2020) (holding that “a veteran’s formal claim is required to identify the sickness, disease, or injuries for which compensation is sought, at least at a high level of generality”). Furthermore, upon review of such earlier filing, the Board finds that such did not identify specific medical records that contained a reasonably ascertainable diagnosis of essential tremor so that such submission may constitute an informal claim for benefits under the pre-March 24, 2015, regulations. Shea v. Wilkie, 926 F.3d 1362 (Fed. Cir. 2019). Specifically, while the Veteran reported receiving treatment for PTSD in June 2007 through VA, a review of such treatment records reflects the Veteran’s report of a classic action tremor, but only note a diagnosis of PTSD. Thus, the Board finds an effective date of October 17, 2007, but no earlier, for the award of service connection for essential tremor is warranted. REASONS FOR REMAND 4. Entitlement to a rating in excess of 50 percent for PTSD and depressive disorder, NOS. In the September 2018 remand, the Board instructed that efforts to obtain the Veteran’s psychiatric treatment records from his private provider, Kaiser Permanente, be made, as he reported receiving ongoing treatment from such provider and the file only contained limited treatment records. However, while some Kaiser Permanente treatment records were associated with the record in March 2019, they were provided by the Veteran in response to a development request regarding his claim for service connection for bladder cancer and only pertain to such disorder. Further, while a subsequent July 2019 letter requested that the Veteran identify any additional treatment records, to include those from Kaiser Permanente, in regard to his claim for an increased rating for his psychiatric disability, it is unclear whether the Veteran was under the impression that he had already provided the records in March 2019. Thus, the Board finds that another remand is necessary in order to attempt to obtain all Kaiser Permanente records pertinent to treatment for the Veterans psychiatric disability. 5. Entitlement to an initial compensable rating for essential tremor. As the Board herein has awarded an earlier effective date of October 17, 2007, for the award of service connection for essential tremor, a remand of the Veteran’s initial rating claim is necessary in order for the AOJ to assign an initial rating for such disability for the period prior to January 30, 2012. The Board further finds that a remand is necessary in order to afford the Veteran a contemporaneous VA examination so as to determine the nature and severity of his essential tremor. In this regard, he was last afforded a VA examination for such disability in March 2012, at which time the purpose of the examination was to establish the etiology of his tremor, as opposed to its severity. Further, the Veteran’s recent VA treatment records reflect his request for an increase in the medication to prescribed to treat his tremor, thus a possible increase in the severity of this disability. Therefore, the Board finds that a new VA examination assessing the severity of the Veteran’s service-connected essential tremor is warranted. The matters are REMANDED for the following action: 1. Afford the Veteran an opportunity to submit, or authorize VA to obtain, all outstanding treatment records pertaining to treatment for his PTSD and depressive disorder, NOS, from Kaiser Permanente. After obtaining any necessary authorization from the Veteran, obtain all outstanding treatment records from such facility. Make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current nature and severity of his service-connected essential tremor. The examiner should review the record and conduct all indicated tests. The examiner should describe the nature and severity of all manifestations of the Veteran’s essential tremor, and describe the functional impact such disability has on his daily life. 3. In connection with the implementation of the Board’s grant of an effective date of October 17, 2007, for the award of service connection for essential tremors, the AOJ should assign an initial rating for such disability for the period prior to January 30, 2012. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Northcutt, 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.