Citation Nr: 21011496 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-00 342A DATE: March 2, 2021 ORDER Entitlement to service connection for residuals of cold injury to the hands and feet is denied. Entitlement to service connection for left thumb disability is denied. Entitlement to an initial rating higher than 10 percent for mild chronic left ankle sprain is denied. Entitlement to an initial compensable rating for dental disability, to include the extraction of wisdom teeth, is denied. REMANDED Entitlement to a rating in excess of 50 percent from November 5, 2010, to September 11, 2019, and in excess of 70 thereafter, for Posttraumatic Stress Disorder (PTSD) and Unspecified Depressive Disorder Due to Military Sexual Trauma is remanded. Entitlement to an initial rating in excess of 10 percent for chronic rhinosinusitis is remanded. Entitlement to a rating in excess of 30 percent for urticaria is remanded. Entitlement to an effective date prior to January 27, 2012, for the grant of service connection for mild chronic left ankle strain is remanded. Entitlement to an effective date prior to November 5, 2010, for the grant of service connection for PTSD and Unspecified Depressive Disorder Due to Military Sexual Trauma is remanded. Entitlement to an effective date prior to November 5, 2010, for the grant of service connection for chronic rhinosinusitis is remanded. Entitlement to an effective date prior to January 27, 2012, for the grant of service connection for dental condition, to include extraction of wisdom teeth, is remanded. Entitlement to an effective date prior to November 5, 2010, for the grant of service connection for headaches is remanded. FINDINGS OF FACT 1. The preponderance of the probative evidence is against finding that residuals of cold injury to the hands and feet began during active service or are otherwise related to an in-service injury or disease. 2. The preponderance of the probative evidence is against finding that a left thumb disability began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the probative evidence of record reflects that for the entire period on appeal, the Veteran’s left ankle disability did not result in moderate or greater levels of limitation. 4. The Veteran does not have any impairment to the mandible, maxilla or ramus nor does she experience any disfiguring of the mouth or osteomyelitis/ osteoradionecrosis/ osteonecrosis of the jaw as a result of the service connected dental disorder. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of cold injury to the hands and feet are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for service connection for left thumb disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (2019). 3. The criteria for an initial rating in excess of 10 percent for mild chronic left ankle sprain are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5271 (2019); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5271). 4. The criteria for a compensable rating for dental disability are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.14.10, 4.150, Diagnostic Codes 9900-9916 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1981 to November 1984 and April 1987 to August 1987. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision issued by the Department of Veterans Affairs Regional Office (RO). Service Connection A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. At 54). 1. Entitlement to service connection for residuals of cold injury to the hands and feet is denied. The Board finds that service connection is not warranted for this claim. The Veteran's inservice medical records did not show any treatment for post-frostbite injuries during active duty. Clinical examination of the feet, the extremities, and skin were all determined to be normal at the time of the November 1984 separation examination. The Veteran completed a Report of Medical History form in connection with the separation examination in November 1984. On this form, she reported that she had or had in the past skin diseases but denied having or ever having had swollen or painful joints, or foot trouble. At separation, she noted that she was in good health, except for headaches caused by stress and her taking medication for a skin condition. She did not mention cold injury residuals or issues with her hands or feet. She also checked “no” as to whether she had ever had foot trouble. This is pertinent because her separation examination included affirmative responses to conditions she previously had during service. Accordingly, this is probative to the finding that the Veteran would have reported the injury at separation. In January 2012, the Veteran wrote that, on a snowy day in January 1982 she sought treatment and was told to go to the hospital. She reported that she was told to wait for a bus. After waiting a half hour, she returned to the medical clinic and reported there was no bus. She was told to return to the bus stop. After waiting another half hour at the bus stop, she reported she could not feel her feet and returned to the clinic. They reportedly informed her she had frostbite. In June 2012, the Veteran complained of pain in the left ankle but no foot complaints. It was also noted the Veteran fell off a truck in January 2011 which resulted, in part, in foot/ankle pain. In March 2016 the Veteran sought treatment for chronic left foot pain she reported was due to an accident in January 2011. The clinical record noted there was a history of plantar fasciitis. The Veteran testified at her May 2018 Board hearing that she injured her hands and feet while waiting in the cold for a bus during service. She alleged that she has had problems with black finger and toe tips; and hypersensitivity to cold in the hands and feet since that time. She alleges she waited for an hour and a half or possibly two hours in the cold. At her September 2019 VA examination, the Veteran reported she had intermittently excruciatingly painful episodes in her hands, and it is sometimes painful to move all the joints of the fingers back to the wrists. She also reported intermittent pain in the bottoms and tops of the feet, toes, and ankles. She said the last time she had the symptoms was the day before her September 2019 VA examination. While scars on her fingers were denied, she said the skin on her fingers sometimes gets yellow and that the symptoms happen in both cold and warm weather. The VA examiner concluded that the Veteran does not have cold injury residuals. It was stated that there were no residuals of cold injury on the hands or feet. Imaging studies were negative for any bony change consistent with frostbite. The examiner noted that the Veteran’s inservice records showed normal skin, upper extremities, and foot examinations. To the extent the Veteran was treated for a skin condition, the examiner observed it was tied to her service-connected urticaria. Thus, the examiner concluded that there was no evidence of residuals of cold injury, no documentation of an injury in service, and that the prior claims for service connection (March 1986 and November 2010) did not include a claim for cold residuals. The Board finds the probative evidence does not support a finding that the Veteran had had cold injuries during active duty and up until the present time. Her allegations of the presence and continuity of the symptoms from military service to the present is undercut by other evidence of record. The Veteran submitted claims for service connection in March 1986, but did not submit claims pertaining to frostbite residuals. The post-service clinical records do not document pertinent complaints or findings. The service treatment records are negative for complaints of, diagnosis or treatment for frostbite residuals. The Board places greater probative weight on the contemporaneous medical records which are either silent as to pertinent complaints and findings or which document complaints regarding the extremities but do not indicate that the complaints have been longstanding or linked to military service. The Board finds that, if the Veteran had had cold injuries and subsequent residuals as alleged, there would have been some indication of this in the service treatment records or in the reports of the post-service medical records. If, in fact the Veteran had had the symptoms from active duty which she thought was due to the cold incident, this would have been reported sooner when seeking treatment for the extremities. The Board notes that if the Veteran's fingers and toes were actually discolored as alleged by the Veteran, this would have been documented by some health care professional. The discoloration would be an obvious problem to a clinician. The failure to do so again undercuts the Veteran's allegations of continuous symptoms – this time allegations of skin discoloring. The Veteran claims her foot problems are attributed to an inservice frostbite incident, but the medical records suggest the reported symptoms are associated with plantar fascitis and a fall the Veteran had in 2011, the year before the Veteran filed a claim for service connection for these purported residuals. The Board finds the September 2019 VA examiner’s conclusion that a current residual frost bite does not exist probative. This conclusion is based on physical examination of the Veteran and a review of the medical evidence. As set out above, the medical history cited in the examination report is found to be correct. The opinion includes a rationale which is based on the lack of physical findings on physical examination as well as the lack of pertinent evidence in the clinical records and service treatment records. The only evidence which indicates the Veteran has cold injuries as a result of military service is the Veteran's own allegations. As a lay person, she is competent to report on symptomology she experiences through her senses. However, as set out above, the Board finds the Veteran's reports of symptomology are not probative when compared with the other evidence. Furthermore, to the extent that the Veteran alleges she currently experiences residuals of cold injuries due to military service, the Board finds this is a complex medical question. As a lay person, the Veteran does not have the requisite medical knowledge and training to accurately provide an opinion as to the etiology of the claimed disorders. In summary, the preponderance of the probative evidence is against this claim. Entitlement to service connection for left thumb disability is denied. The Board finds that service connection is not warranted for a left thumb disorder. The Veteran reported in January 2012 correspondence and testified at her May 2018 travel board hearing that she injured her left thumb during service. She reported that while going through training on an anti-tank weapon, a rod went through her left thumb. She was treated by flushing the wound and then wrapping it. She alleged that she has had problems with her thumb ever since the injury. She alleged that she has had problems holding objects and that she had dropped objects due to the thumb. At her May 2018 Board hearing, the Veteran denied that she did anything after discharge to injure the thumb and that, to the best of her knowledge, the only place she could have injured her thumb was during active duty. She alleged that she had thumb symptoms at discharge which continued to the present time. The Veteran underwent a VA examination in September 2019 for her bilateral hands. The examination reported that the Veteran did not have a cold injury residual, but a current diagnosis otherwise was not reported. The examination reported the Veteran’s range of motion and functional limitations for the bilateral hands were “all normal.” The examination was negative for a gap between the pad of the thumb and the fingers of the bilateral hands; and negative for a gap between the finger and proximal transverse crease of the left hand on maximal finger flexion. A review of the Veteran’s inservice medical records are negative for an injury to the left thumb. At her separation examination in November 1984, she reported to be in general good health with the exception of stress headaches and a skin condition. She denied having a loss of finger and she reported normal upper extremities at this November 1984 separation examination. The Board acknowledges that the Veteran reported at her May 2018 travel board hearing that her thumb has been going out on her and that things fall out of her hand. Thus, in the context of Saunders, there may be an argument that the Veteran has a compensable disability due to her testimony reporting her thumb is functionally limited because she cannot always hold onto things. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). Moreover, post service medical records corroborate the report that the Veteran’s left thumb occasionally locks up on her. A September 2003 VA women’s health initial visit record reports the Veteran had pain in both of her thumbs, and her left was injured in a motor vehicle accident. A later October 2003 rheumatology consultation reported the Veteran had an injury in her left thumb in 1993. In January 2004, she reported injuring her thumbs twice in December 2003. In July 2009, it was reported the Veteran had a motor vehicle accident that resulted in a left thumb injury. In January 2010 the Veteran was reportedly enrolled in physical therapy for a thumb injury/dislocation as a result of an October 2008 motor vehicle accident. To that extent, the medical record indicates the Veteran has a current thumb disability, but the records document that it had its onset after service and is due to a motor vehicle accident. The Veteran reported at her hearing that she did not do anything else to injure her thumb after service. Significantly, as demonstrated by the objective medical records from September 2003 to January 2010, the Veteran was treated for a post-service injury to the thumb. This conflicting evidence causes the Board to place reduced probative value on the Veteran's report of the history of her thumb injury. It is not apparent to the Board why the Veteran would deny post-service injury to the thumb at the time of the hearing when, in fact, she sought treatment several times for a post-service injury. The Board finds that not only may the Veteran's memory have dimmed with time but the potential for pecuniary gain may have swayed the more recent comments. Accordingly, the Board does not find her statements regarding her thumb condition’s etiology are credible, and they are therefore not probative. The September VA 2019 examiner did not address the Veteran’s lay statements from her Board hearing reporting that she injured her thumb during a training for a lethal weapon and that she could not hold onto things sometimes. While the Board acknowledges that the September 2019 VA examiner did not address the Veteran’s reports of an inservice injury to her left thumb and as to whether the Veteran had a current diagnosis consistent with these claims, a remand is not warranted in this case because the Veteran’s reports regarding this injury are found to not be credible. Accordingly, the preponderance of the evidence is against this claim, and service connection is not warranted. The Board has considered that the Veteran had a short tour of active duty in 1987. There are medical records associated with the time period do not document any pertinent complaints of, diagnosis of or treatment for a thumb injury or disorder. Increased Rating Generally, disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. However, the Court has held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (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 throughout the appeal, the assignment of staged ratings would be necessary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 2. Entitlement to an initial rating higher than 10 percent for chronic left ankle sprain is denied. In an August 2012 rating decision, service connection was granted with a 10 percent rating, and an effective date of January 27, 2012. The Veteran has disagreed with the initial rating assigned. Law The Veteran has been rated under Diagnostic Code 5270 for ankylosis of the ankle, but the claims record does not indicate the Veteran has experienced ankylosis in her left ankle at any time during the period on appeal. The Board finds the appropriate Diagnostic Code for evaluation of the left ankle sprain is Diagnostic Code 5271 which provides ratings based on limitation of motion of the ankle. Under this Diagnostic Code a 10 percent rating is warranted with moderate limitation of motion and a 20 percent rating is warranted for marked limitation of motion. Standard range of motion of an ankle is 0 to 20 degrees of dorsiflexion and 0 to 45 degrees of plantar flexion. 38 C.F.R. § 4.71 Plate II. Prior to February 7, 2021, the schedule of ratings did not provide information as to what manifestations constitute “moderate” or “marked” limitation of ankle motion, but guidance could be found in the VA Adjudication Procedures Manual (M21-1). The M21-1 states that moderate limitation of ankle motion is present when there is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, while marked limitation of motion is demonstrated when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. See M21-1, III.iv.4.A.3.k. The M21-1 is not binding on the Board. However, the Board must address relevant provisions of the M21-1 and conduct an independent analysis before determining whether the provisions may be relied upon as a factor to support its decision. Overton v. Wilkie, 30 Vet. App. 257 (2018). Moreover, as of February 7, 2021, Diagnostic Code 5271 has been amended and it defines “moderate” and “marked” limitation. These amendments are consistent with the M21-1. Under the amended diagnostic code, moderate limitation of the ankle is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion; warranting a 10 percent rating; and marked limitation of the ankle is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5271). Because the Veteran’s ankle disability is based upon limitation of motion the Board must also consider, in conjunction with the otherwise applicable Diagnostic Code, any additional functional loss that the Veteran may have sustained by virtue of other factors: less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. 38 C.F.R. § §§ 4.40, 4.45 (2019); DeLuca v. Brown, 8 Vet. App. 202 (1995). Facts The Veteran underwent a VA examination in June 2012 for her ankles. She reported pain coming downstairs and prolonged walking and standing for more than 3 to 4 blocks. She took prescription medication for the pain. She did not wear a brace or any other assistive devices. On physical examination it was reported she had a normal gait. She had active and passive range of motion in her left ankle with the use of goniometer x 3. Her plantar flexion was 0 to 45 degrees with mild objective evidence of painful motion at 45 degrees. Her dorsiflexion was 0 to 30 degrees with no objective evidence of painful motion. After repetitive use, range of motion was not additionally limited with pain, weakness, or fatigability. There was not deformity, atrophy of disuse, disturbance of locomotion, interference with sitting, standing, or weightbearing on her ankle. She had a mild complaint of tenderness on palpation of her joints and soft tissues of the medial talar dome. Her muscle strength was 5/5 on the ankle plantar flexion and dorsiflexion. There was no joint instability. There was no evidence of ankylosis of the ankle, subtalar and tarsal joint. There was no evidence of shin splint, stress fracture of lower extremities, achilles tendinitis, or malunion of the calcaneus. Scars were not reported. Additionally, there were no pertinent physical findings, complications, or conditions on the left ankle. It was reported that a previous MRI of the left ankle in December 2011 did not show arthritis, fracture, or dislocation. In May 2014, a private examiner reported during a physical examination of the Veteran that the left ankle did not have any heat, swelling, or inflammation. She could stand on her toes and her heels. The left ankle and foot moved well in all planes with normal strength and sensation. At the Veteran’s May 2018 travel board hearing, she reported that her service-connected conditions have resulted in eight falls and instability. She reported that she had pain and while she had bought a bike, she could not ride it because it was too excruciating. She reported that on an average of four days a year, the pain is so bad that she cannot walk on it and on a scale from 1 to 10, her ankle was always at a 4 or 5, but she has had flares of pain with a level of 10. Again, in September 2019, the Veteran underwent a VA examination. This examination was requested by the Board in its October 2018 remand. The Veteran denied flare-ups of the ankle symptoms. Her left ankle range of motion was reported to be abnormal and outside of range. Dorsiflexion was reported to be 0 to 10 degrees and plantar flexion was 0 to 40 degrees. Repetitive use testing was conducted. There was no additional loss of function or range of motion after this testing. While abnormal, the examiner opined the symptoms did not contribute to functional loss. The Veteran denied experiencing functional loss. While pain was noted, again, the examiner found it did not cause functional loss. The examination was negative for pain with weightbearing, localized tenderness or pain on palpation, or crepitus. Muscle strength was normal and there was no muscle atrophy, ankylosis or joint instability. Analysis The Board finds that the record does not support that the Veteran’s left ankle disability resulted in marked limitation of motion and a higher rating based on limitation of motion is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Board does not consider the M21-1 provision to be binding but finds it persuasive. Particularly since it is consistent with the February 7, 2021 amendments to this diagnostic code. Based on the M21-1 provision along with the February 7, 2021 amendments, the Veteran’s does not meet the criteria for a higher rating. The Veteran’s range of motion has been at its worse, 0 to 10 degrees dorsiflexion and 0 to 40 degrees for plantar flexion. This is not consistent with marked limitation which may be demonstrated with range of motion closer to when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. See M21-1, III.iv.4.A.3.k and Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5271). While reports of pain and functional loss, including reported instability, have been reported for this period, functional loss due to pain is contemplated by the assigned 10 percent rating, and there is no indication of additional functional loss warranting a higher level of compensation. See 38 C.F.R. §§ 4.40, 4.45, 4.59. To the extent that the Veteran testified she experience falls and instability due to the ankle, the Veteran is competent to report such symptomology. Significantly, no health care professional has documented the presence of any instability in the ankle. Consistent physical examinations failed to document such and the clinical records are silent as to pertinent complaints. The only examiner which documents this symptomology is the testimony at the hearing. The Board finds the objective evidence of no pertinent physical findings and a lack of any consistent report in the record of the presence of instability of the ankle by the Veteran outweighs her testimony that the instability that reportedly resulted in at least 8 falls. The Board finds that if, in fact the symptomology was productive of numerous falls, this would have been reported to a health care professional. Lack of any pertinent evidence caused the Board to place no probative value on the Veteran's allegation of experiencing falls as a result of her ankle disorder. The Board also considers whether an increased rating is warranted under other Diagnostic Codes pertaining to the ankle. However, the Veteran retains the ability to move her ankle, therefore she does not have ankylosis and Diagnostic Code 5270 or 5272 are not appropriate. Moreover, malunion of the os calcis or astragalus, or astragalectomy have not been reported during the appeal period. Thus, a rating under Diagnostic Code 5273 or 5274 are also not warranted. The Veteran is competent to report her experienced symptoms of her ankle. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Because the preponderance of the probative evidence, including the Veteran’s competent and credible lay statements, is against a finding of marked limitation of motion of her ankle, the claim must be denied. Accordingly, preponderance of the evidence is against the claim, and the claim is denied. 3. Entitlement to an initial compensable rating for dental disability is denied. At the Veteran’s May 2018 Board hearing she reported that she has had problems since having a dental surgery, including issues with her sinuses. She reported since having this surgery she is sensitive to fresh cut grass, and “all types of things.” She reported that it did not feel like her jaw fit, and that her teeth were misaligned. The Veteran’s service-connected condition is not compensable. The Veteran is service connected for the extraction of wisdom teeth. As seen as recent as the September 2019 VA examination, the Veteran does not have any impairment to the mandible, maxilla or ramus as a result of this condition. She doesn’t have any disfiguring to her mouth or osteomyelitis/ osteoradionecrosis/ osteonecrosis of the jaw. The dental conditions for which service-connected compensation benefits are available are set under 38 C.F.R. § 4.150, DCs 9900-9916. Disability compensation and VA outpatient dental treatment may be provided only for certain specified types of service-connected dental disorders. For other types of service-connected dental disorders, the claimant may receive treatment only and not compensation. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. Impacted wisdom teeth are not listed as eligible for compensation. At most, loss of teeth would be compensable, but even then only as a result of trauma or disease of the bone of the jaw. 38 C.F.R. § 4.150, Diagnostic Code 9913. The Board does not find the Veteran’s reports of a misaligned jaw probative. While she is competent to report her symptoms, she lacks the medical expertise to assess whether her jaw is aligned. To that extent the Board finds her statements are not probative. As noted, the Veteran’s September 2019 VA examination was negative for any impact to her jaw, so accordingly, the claim is denied. REASONS FOR REMAND 5. Entitlement to a rating in excess of 50 percent from November 5, 2010, to September 11, 2019, and in excess of 70 thereafter, for Posttraumatic Stress Disorder and Unspecified Depressive Disorder Due to Military Sexual Trauma is remanded. In January 2012, the Veteran reported that she was currently receiving treatment from a private LCSW. More recently, at her September 2019 VA examination, she reported treatment by a non-VA therapist. To that extent, the Board finds the duty to assist has been triggered, and a remand to obtain these relevant treatment records is needed. 6. Entitlement to an initial rating in excess of 10 percent for chronic rhinosinusitis is remanded. The Veteran reports she has obtained private treatment for her sinus attacks. Her July 2012 VA examination reports treatment from an allergist, Dr. Larosa, at Presbyterian hospital. A remand is needed to obtain the Veteran’s private medical records associated with her sinus treatment. 7. Entitlement to an initial compensable rating from November 5, 2010 to March 26, 2015, and in excess of 30 percent thereafter for urticaria is remanded. At the Veteran’s recent September 2019 VA examination, she reported that she did not currently have active urticaria at the time of the examination. Yet it was later reported that the Veteran was receiving a topical treatment of zinc oxide to treat her urticaria, and that the treatment was a third line treatment. However, it is not clear to the Board if the Veteran’s prescription of zinc oxide was a third line treatment and whether it was for the Veteran’s service-connected condition of urticaria. Accordingly, a remand is needed for clarification as to the seemingly inconsistent finding on the September 2019 VA examination. Effective Dates In response to the August 2012 rating decision on appeal, the Veteran filed a statement in support of claim on a VA 21-4138 in October 2012 reporting that she was in disagreement with the effective dates of the claims and that they should be in 1985. The VA notified the Veteran in April 2013 that the form was not a valid notice of disagreement (NOD) as it lacked specificity as to the intent to appeal and to the issues that were in dispute. She followed up with a July 2013 Form 9. On this form she reported, again, that the effective dates of 2010 were incorrect, and that they should be in 1985. In October 2013, the VA accepted this July 2013 Form 9 as a notice of disagreement with the August 2012 rating decision. However, to date, the Regional Office (RO) has yet to issue a Statement of the Case (SOC) in response to the Veteran’s July 2013 notice of disagreement for her effective dates. Therefore, the Board must remand the issues to the RO for the issuance of a statement of the case. See Manlicon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain update VA and private records, the Board is particularly interested in the records associated with the Veteran’s treatment for her acquired psychiatric and sinus disabilities, including those records from the treatment she received with D. Harris, LCSW and the practitioner referenced at her September 2019 VA psychiatric examination; and those referenced in her July 2012 VA sinus examination. 3. Obtain and addendum medical opinion from a suitably qualified health care professional to answer the following questions. An examination of the Veteran should only be scheduled if this is required to obtain the requested opinion.: (a.) Whether the Veteran has received treatment for urticaria with first line treatments (antihistamines), second line treatments (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control, or third line treatment for control (e.g., plasmapheresis, immunotherapy, immunosuppressives). (b.) If the clinician finds that none of the Veteran’s medications fell into one of the above categories, please opine as to whether the medication(s) administered are considered first, second, or third-line treatments. 1. In answering (b.), the VA examiner should address the September 2019 VA examination that reported the Veteran’s zinc oxide is a third line treatment for her urticaria. The examiner should consider all lay and medical evidence of record. A supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. 4. Furnish the Veteran a SOC for her claims for entitlement to an earlier effective date for the grant of service connection for PTSD, chronic rhinosinusitis, mild left ankle strain, headaches and dental condition. The Veteran must be informed that in order to perfect an appeal of these issues, she must timely file a substantive appeal, following the issuance of the SOC. If an appeal is perfected, and after any further action deemed warranted, certify the matter to the Board unless the issues are resolved to the Veteran’s satisfaction. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.