Citation Nr: 21011683 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-12 255 DATE: March 2, 2021 ORDER New and material evidence having been received, the appeal to reopen service connection for bilateral hearing loss is granted. New and material evidence having been received, the appeal to reopen service connection for tinnitus is granted. New and material evidence not having been received, the appeal to reopen service connection for Gulf War syndrome is denied. New and material evidence not having been received, the appeal to reopen service connection for a head injury is denied. New and material evidence not having been received, the appeal to reopen service connection for headaches is denied. New and material evidence not having been received, the appeal to reopen service connection for a bilateral eye disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a mouth condition is denied. New and material evidence not having been received, the appeal to reopen service connection for a tooth condition is denied. New and material evidence not having been received, the appeal to reopen service connection for a tongue condition is denied. New and material evidence not having been received, the appeal to reopen service connection for a jaw condition is denied. New and material evidence not having been received, the appeal to reopen service connection for a sinus condition (also claimed as sinusitis, allergies, nose condition, and/or rhinitis) is denied. New and material evidence not having been received, the appeal to reopen service connection for loss of sense of smell is denied. New and material evidence not having been received, the appeal to reopen service connection for loss of sense of taste is denied. New and material evidence not having been received, the appeal to reopen service connection for sleep apnea is denied. New and material evidence not having been received, the appeal to reopen service connection for chronic fatigue syndrome (CFS) is denied. New and material evidence not having been received, the appeal to reopen service connection for a nonspecific respiratory condition is denied. New and material evidence not having been received, the appeal to reopen service connection for fibromyalgia is denied. New and material evidence not having been received, the appeal to reopen service connection for a digestive disorder (also claimed as bowel condition, gastrointestinal disorder, intestinal condition, and irritable bowel syndrome (IBS)) is denied. New and material evidence not having been received, the appeal to reopen service connection for a bilateral testicular condition is denied. New and material evidence not having been received, the appeal to reopen service connection for a neck disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a left shoulder disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a left wrist disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a right wrist disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a left hand disability is denied. New and material evidence not having been received, the appeal to reopen service connection for scars on the left hand is denied. New and material evidence not having been received, the appeal to reopen service connection for a left hip disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a right hip disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a left knee disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a right knee disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a left ankle disability is denied. New and material evidence not having been received, the appeal to reopen service connection for a right ankle disability is denied. Service connection for posttraumatic stress disorder (PTSD) is granted. Service connection for bruxism, as secondary to PTSD, is granted. Service connection for enlarged tori, as secondary to PTSD, is granted. Service connection for tinnitus is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to an initial rating in excess of 10 percent for thoracolumbar sprain (“back disability”) is remanded. Entitlement to an initial rating in excess of 20 percent for right shoulder acromioclavicular joint osteoarthritis (“right shoulder disability”) is remanded. FINDINGS OF FACT 1. Service connection for Gulf War syndrome was denied in a November 2012 rating decision and the Veteran did not appeal the issue. 2. The Veteran requested to reopen the claim for service connection for Gulf War syndrome in February 2016, which was denied in an August 2016 rating decision. The Veteran did not appeal the decision. 3. Evidence received since the August 2016 rating decision is new but not material and does not support the applications to reopen service connection for Gulf War syndrome. 4. Service connection for a bilateral eye condition, headaches, nonspecific respiratory condition, CFS, fibromyalgia, left hand condition, jaw condition, left ankle condition, left hip condition, left knee condition, left shoulder condition, left wrist condition, neck condition, right ankle condition, right hip condition, right knee condition, right wrist condition, scars, sinusitis, sleep apnea, loss of smell, loss of taste, bilateral testicular condition, tinnitus, tongue condition, tooth condition, and hearing loss were denied in an August 2016 rating decision and the Veteran did not appeal the decision. 5. Evidence received since the August 2016 rating decision with regard to the claims for service connection for hearing loss and tinnitus is new in that it is not cumulative and was not previously considered by decision makers, and it is material because it raises a reasonable possibility of substantiating the claims for service connection. 6. Evidence received since the August 2016 rating decision with regard to the claims for service connection for a bilateral eye condition, headaches, nonspecific respiratory condition, CFS, fibromyalgia, left hand condition, jaw condition, left ankle condition, left hip condition, left knee condition, left shoulder condition, left wrist condition, neck condition, right ankle condition, right hip condition, right knee condition, right wrist condition, scars, sinusitis, sleep apnea, loss of smell, loss of taste, bilateral testicular condition, tongue condition, and tooth condition is new but not material and does not support the applications to reopen service connection. 7. Service connection for a head injury and a mouth condition were denied in a February 2017 rating decision and the Veteran did not appeal the decision. 8. Evidence received since the February 2017 rating decision with regard to the claims for service connection for a TBI and a mouth condition is new but not material and does not support the applications to reopen service connection. 9. The evidence is at least in equipoise on whether the Veteran has a diagnosis of PTSD that is related to in-service stressors. 10. The Veteran has a diagnosis of bruxism, which is due to his PTSD. 11. The Veteran has a diagnosis of enlarged tori, which is due to his PTSD. 12. The Veteran has a diagnosis of tinnitus, and the evidence is at least in equipoise on whether it is related to service. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the claim for service connection for bilateral hearing loss. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 2. New and material evidence has been received to reopen the claim for service connection for tinnitus. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 3. New and material evidence has not been received to reopen the claim for service connection for Gulf War syndrome. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 4. New and material evidence has not been received to reopen the claim for service connection for a bilateral eye disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103 5. New and material evidence has not been received to reopen the claim for service connection for a mouth condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 6. New and material evidence has not been received to reopen the claim for service connection for a tooth condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 7. New and material evidence has not been received to reopen the claim for service connection for a tongue condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 8. New and material evidence has not been received to reopen the claim for service connection for a jaw condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 9. New and material evidence has not been received to reopen the claim for service connection for a sinus condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 10. New and material evidence has not been received to reopen the claim for service connection for loss of sense of smell. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 11. New and material evidence has not been received to reopen the claim for service connection for loss of sense of taste. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 12. New and material evidence has not been received to reopen the claim for service connection for sleep apnea. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 13. New and material evidence has not been received to reopen the claim for service connection for CFS. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 14. New and material evidence has not been received to reopen the claim for service connection for a nonspecific respiratory condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 15. New and material evidence has not been received to reopen the claim for service connection for fibromyalgia. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 16. New and material evidence has not been received to reopen the claim for service connection for a digestive disorder. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 17. New and material evidence has not been received to reopen the claim for service connection for a neck disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 18. New and material evidence has not been received to reopen the claim for service connection for a left shoulder disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 19. New and material evidence has not been received to reopen the claim for service connection for a left wrist disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 20. New and material evidence has not been received to reopen the claim for service connection for a left hand disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 21. New and material evidence has not been received to reopen the claim for service connection for scars. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 22. New and material evidence has not been received to reopen the claim for service connection for a right hip disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 23. New and material evidence has not been received to reopen the claim for service connection for a left knee disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 24. New and material evidence has not been received to reopen the claim for service connection for a right knee disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 25. New and material evidence has not been received to reopen the claim for service connection for a left ankle disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 26. New and material evidence has not been received to reopen the claim for service connection for a right ankle disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 27. New and material evidence has not been received to reopen the claim for service connection for a bilateral testicular condition. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 28. New and material evidence has not been received to reopen the claim for service connection for a head injury. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103 29. New and material evidence has not been received to reopen the claim for service connection for headaches. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 30. New and material evidence has not been received to reopen the claim for service connection for a left hip disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 31. The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 32. The criteria for service connection for bruxism as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 33. The criteria for service connection for enlarged tori as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 34. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from April 2002 to January 2004, including service in Southwest Asia. In January 2021, the Veteran testified at a videoconference hearing before the undersigned, and a transcript of that hearing is of record. New and Material Evidence Rating decisions from which an appeal is not perfected become final. 38 U.S.C. § 7105; 38 C.F.R. § § 20.1103. An appeal consists of a timely filed notice of disagreement in writing, and after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § § 20.200. To reopen a claim that has been denied by a final decision, new and material evidence must be received. 38 U.S.C. § 5108. New and material evidence means evidence not previously submitted to agency decisionmakers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened; and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § § 3.156(a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied, but instead should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1994); Justus v. Principi, 3 Vet. App. 510, 513 (1992). 1. New and material evidence to reopen service connection for bilateral hearing loss. 2. New and material evidence to reopen service connection for tinnitus. The claims for service connection for hearing loss and tinnitus were denied in an August 2016 rating decision. The Regional Office (RO) noted that the Veteran’s hearing loss did not meet the criteria to be considered a hearing loss disability for VA purposes and there was no current diagnosis of tinnitus. The Veteran did not appeal the August 2016 rating decision and it is final. The Veteran requested to reopen the claims in April 2018. The additional relevant evidence received since the August 2016 rating decision includes a private medical opinion and the Veteran’s Board hearing testimony. The Veteran testified in the Board hearing that his hearing loss had worsened, and he submitted medical opinion indicating that he had a diagnosis of tinnitus that was related to service. Presumed credible, the medical opinion and the Veteran’s Board testimony are probative evidence that the Veteran has hearing loss and tinnitus that could be related to service. Accordingly, new and material evidence has been received to reopen the claims for service connection for hearing loss and tinnitus. 3. New and material evidence to reopen service connection for Gulf War syndrome. The Veteran submitted a claim for service connection for Gulf War syndrome in September 2011, which was denied in a November 2012 rating decision. Evidence included service treatment records (STRs), the application for disability compensation benefits, and a May 2012 VA examination report. The RO noted that there was no evidence of a chronic multi-symptom undiagnosed illness that could be due to Gulf War service. The Veteran did not appeal the issue. As such, the decision is final. The Veteran requested to reopen the claim for service connection for Gulf War syndrome in February 2016, which was denied in an August 2016 rating decision. Relevant additional evidence received included the application for disability compensation benefits and an August 2016 VA examination report. The RO noted that the examination report indicated there were no signs or symptoms that represented an undiagnosed illness or diagnosed medically unexplained chronic multi-system illness. The Veteran did not appeal the decision and it is final. The Veteran submitted the current request to reopen the claim for service connection for Gulf War syndrome in April 2018. Relevant evidence received since the August 2016 rating decision includes the application for disability compensation benefits, a July 2018 VA examination report, and the Veteran’s testimony in the January 2021 Board hearing. The Board finds that the evidence received since the August 2016 rating decision is new, but it is not material because it does not relate to an unestablished fact necessary to substantiate the claim for service connection for Gulf War syndrome. Specifically, the evidence does not indicate that the Veteran has chronic multi-symptom undiagnosed illness that could be due to Gulf War service. To the extent to which the Veteran asserts that he has such a condition, this is cumulative of statements previously made by him. Reid v. Derwinski, 2 Vet. App. 312 (1992). See also Bostain v. West, 11 Vet. App. 124 (1998) (lay hearing testimony that is cumulative of previous contentions considered by decision maker at time of prior final disallowance of the claim is not new evidence). Thus, the Veteran’s lay statements on their own are not sufficient to serve as new and material evidence to reopen the claim. The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and as described the evidence that has been added since August 2016 does not reach that threshold. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The evidence submitted since the August 2016 rating decision does not relate to an unestablished fact necessary to substantiate the claim for service connection for Gulf War syndrome, and the appeal to reopen service connection is denied. 4. New and material evidence to reopen service connection for a bilateral eye disability. 5. New and material evidence to reopen service connection for a tooth condition. 6. New and material evidence to reopen service connection for a tongue condition. 7. New and material evidence to reopen service connection for a jaw condition. 8. New and material evidence to reopen service connection for a sinus condition. 9. New and material evidence to reopen service connection for loss of smell. 10. New and material evidence to reopen service connection for loss of taste. 11. New and material evidence to reopen service connection for sleep apnea. 12. New and material evidence to reopen service connection for CFS. 13. New and material evidence to reopen service connection for a nonspecific respiratory condition. 14. New and material evidence to reopen service connection for fibromyalgia. 15. New and material evidence to reopen service connection for a digestive disorder. 16. New and material evidence to reopen service connection for a bilateral testicular condition. 17. New and material evidence to reopen service connection for a left shoulder disability. 18. New and material evidence to reopen service connection for a left wrist disability. 19. New and material evidence to reopen service connection for a right wrist disability. 20. New and material evidence to reopen service connection for a left knee disability. 21. New and material evidence to reopen service connection for a right knee disability. 22. New and material evidence to reopen service connection for a left ankle disability. 23. New and material evidence to reopen service connection for a right ankle disability. The claims for service connection for a bilateral eye disability, tooth condition, tongue condition, jaw condition, sinus condition, loss of smell, loss of taste, sleep apnea, CFS, nonspecific respiratory condition, fibromyalgia, digestive disorder, bilateral testicular condition, left shoulder disability, bilateral wrist disability, bilateral knee disability, and bilateral ankle disability were denied in an August 2016 rating decision. The RO noted that the Veteran’s only eye diagnosis was presbyopia related to age. Any loss of vision due to refractive errors, including presbyopia, is not eligible for service connection. 38 C.F.R. § 3.303(c); see also 38 C.F.R. § 4.9. The Veteran did not have current diagnoses of any tooth condition, tongue condition, jaw condition, sinus condition, loss of smell, loss of taste, sleep apnea, CFS, nonspecific respiratory condition, fibromyalgia, digestive disorder, testicular condition, left shoulder diagnosis, left or right wrist diagnosis, left or right knee diagnosis, or left or right ankle disorder. The evidence at the time of the August 2016 rating decision included an intent to file received in November 2015, the application for disability compensation benefits received in February 2016, STRs, private Disability Benefits Questionnaires (DBQs) dated in November 2014 completed by Dr. J.T., a letter from Dr. J.T., and VA examinations dated in August 2016. The Veteran did not appeal the August 2016 rating decision and it is final. The Veteran submitted the current request to reopen these claims April 2018. Relevant evidence received since the August 2016 rating decision includes the application for disability compensation benefits, VA treatment records, and the Veteran’s testimony in the January 2021 Board hearing. The Board finds that the evidence received since the August 2016 rating decision is new, but it is not material because it does not relate to an unestablished fact necessary to substantiate the claims for service connection for a bilateral eye disability, tooth condition, tongue condition, jaw condition, sinus condition, loss of smell, loss of taste, sleep apnea, CFS, nonspecific respiratory condition, fibromyalgia, digestive disorder, bilateral testicular condition, left shoulder disability, bilateral wrist disability, bilateral knee disability, or bilateral ankle disability. Specifically, the evidence does not indicate that the Veteran has a diagnoses of any eye condition, tooth condition, tongue condition, jaw condition, sinus condition, loss of smell, loss of taste, sleep apnea, CFS, nonspecific respiratory condition, fibromyalgia, digestive disorder, testicular condition, left shoulder diagnosis, left or right wrist diagnosis, left or right knee diagnosis, or left or right ankle disorder. To the extent to which the Veteran asserts that he has these conditions, this is cumulative of statements previously made by him. Reid v. Derwinski, 2 Vet. App. 312 (1992). See also Bostain v. West, 11 Vet. App. 124 (1998) (lay hearing testimony that is cumulative of previous contentions considered by decision maker at time of prior final disallowance of the claim is not new evidence). Thus, the Veteran’s lay statements on their own are not sufficient to serve as new and material evidence to reopen the claims. The Board acknowledges that in January 2021, the Veteran resubmitted DBQs completed by Dr. J.T. in November 2014. These DBQs were already considered in the August 2016 rating decisions, which lists “multiple Disability Benefits Questionnaires” received in February 2016 and refers to medical evidence received from the Veteran throughout the decision. As such, these DBQs are duplicative of evidence already of record, and do not constitute new evidence. The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and as described the evidence that has been added since August 2016 does not reach that threshold. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The evidence submitted since the August 2016 rating decision does not relate to an unestablished fact necessary to substantiate the claims for service connection for an eye condition, tooth condition, tongue condition, jaw condition, sinus condition, loss of smell, loss of taste, sleep apnea, CFS, nonspecific respiratory condition, fibromyalgia, digestive disorder, testicular condition, left shoulder diagnosis, left or right wrist diagnosis, left or right knee diagnosis, or left or right ankle disorder, and the appeals to reopen service connection are denied. 24. New and material evidence to reopen service connection for headaches. 25. New and material evidence to reopen service connection for a neck disability. 26. New and material evidence to reopen service connection for a left hand disability. 27. New and material evidence to reopen service connection for scars. 28. New and material evidence to reopen service connection for a left hip disability. 29. New and material evidence to reopen service connection for a right hip disability. The claims for service connection for headaches, a neck disability, left hand disability, scars, a left hip disability, and a right hip disability were denied in an August 2016 rating decision. The RO noted that the Veteran had diagnoses relevant to these claimed conditions, but there was no evidence of a link between the diagnosed conditions and the Veteran’s military service. The evidence at the time of the August 2016 rating decision included an intent to file received in November 2015, the application for disability compensation benefits received in February 2016, STRs, private DBQs dated in November 2014 completed by Dr. J.T., a letter from Dr. J.T., and VA examinations dated in August and 2016. The Veteran did not appeal the August 2016 rating decision and it is final. The Veteran submitted the current requests to reopen the claims for service connection for headaches, a neck disability, left hand disability, scars, a left hip disability, and a right hip disability in April 2018. Relevant evidence received since the August 2016 rating decision includes the application for disability compensation benefits, VA treatment records, and the Veteran’s testimony in the January 2021 Board hearing. The Board finds that the evidence received since the August 2016 and February 2017 rating decisions is new, but it is not material because it does not relate to an unestablished fact necessary to substantiate the claims for service connection for headaches, a neck disability, left hand disability, scars, a left hip disability, or a right hip disability. Specifically, the evidence does not contain a link between the claimed disabilities and the Veteran’s military service. To the extent to which the Veteran asserts that these conditions are related to his service, this is cumulative of statements previously made by him. Reid v. Derwinski, 2 Vet. App. 312 (1992). See also Bostain v. West, 11 Vet. App. 124 (1998) (lay hearing testimony that is cumulative of previous contentions considered by decision maker at time of prior final disallowance of the claim is not new evidence). Thus, the Veteran’s lay statements on their own are not sufficient to serve as new and material evidence to reopen the claims. The Board acknowledges that in January 2021, the Veteran resubmitted DBQs completed by Dr. J.T. in November 2014. These DBQs were already considered in the August 2016 rating decisions, which lists “multiple Disability Benefits Questionnaires” received in February 2016 and refers to medical evidence received from the Veteran throughout the decision. As such, these DBQs are duplicative of evidence already of record, and do not constitute new evidence. Moreover, even if the resubmitted DBQs constitute new evidence, they do not contain opinions that the conditions were related to service except by the Veteran’s own reports, which are cumulative of statements previously made by him. The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and as described the evidence that has been added since August 2016 and February 2017 does not reach that threshold. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The evidence submitted since the prior rating decisions does not relate to an unestablished fact necessary to substantiate the claims for service connection for headaches, a neck disability, left hand disability, scars, a left hip disability, or a right hip disability, and the appeals to reopen service connection are denied. 30. New and material evidence to reopen service connection for a head injury. 31. New and material evidence to reopen service connection for a mouth condition. The claims for service connection for a head injury and a mouth condition were denied in a February 2017 rating decision. The RO noted that the Veteran was diagnosed with a traumatic brain injury (TBI) in a September 2016 VA examination; however, the examiner did not complete the examination report to VA standards. As such, another examination was rescheduled for November 2016, which the Veteran canceled. The examination was rescheduled twice in December 2016, both of which the Veteran canceled. As such, the VA examination associated with the claims file was not completed, nor was the medical opinion. Similarly, the Veteran was scheduled for a VA examination in connection with the claim for service connection for a mouth condition, which the Veteran canceled. The evidence at the time of the February 2017 rating decision included an intent to file received in November 2015, the application for disability compensation benefits received in February 2016, STRs, private DBQs dated in November 2014 completed by Dr. J.T., a letter from Dr. J.T., and the September 2016 VA examination report. The Veteran did not appeal the February 2017 rating decision and it is final. The Veteran submitted the current requests to reopen the claims for service connection for a head injury and a mouth condition in April 2018. Relevant evidence received since the August 2016 rating decision includes the application for disability compensation benefits, VA treatment records, and the Veteran’s testimony in the January 2021 Board hearing. The Board finds that the evidence received since the February 2017 rating decisions is new, but it is not material because it does not relate to an unestablished fact necessary to substantiate the claims for service connection for a head injury or mouth condition. Specifically, the evidence does not contain a link between the claimed disabilities and the Veteran’s military service. To the extent to which the Veteran asserts that these conditions are related to his service, this is cumulative of statements previously made by him. Reid v. Derwinski, 2 Vet. App. 312 (1992). See also Bostain v. West, 11 Vet. App. 124 (1998) (lay hearing testimony that is cumulative of previous contentions considered by decision maker at time of prior final disallowance of the claim is not new evidence). Thus, the Veteran’s lay statements on their own are not sufficient to serve as new and material evidence to reopen the claims. The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and as described the evidence that has been added since August 2016 and February 2017 does not reach that threshold. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The evidence submitted since the prior rating decisions does not relate to an unestablished fact necessary to substantiate the claims for service connection a head injury or mouth condition and the appeals to reopen service connection are denied. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). Certain disease, including tinnitus and arthritis, are listed among the “chronic diseases” under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 32. Service connection for PTSD. 33. Service connection for bruxism. 34. Service connection for enlarged tori. The Veteran contends that he has PTSD due to combat experiences in Iraq, including experiencing enemy attacks, almost being killed by a friendly-fire missile with a broken stabilizer fin, witnessing an explosion of a chemical plant and seeing the aftermath including “countless dead bodies,” and engaging in direct shooting at enemies. See the April 2015 statement. Service connection for PTSD generally requires medical evidence establishing a diagnosis of the disorder, credible supporting evidence that the claimed in-service stressor(s) actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). The PTSD diagnosis must be made in accordance with the criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Id.; 38 C.F.R. § 4.125(a). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). Additionally, lay evidence alone may establish an alleged stressor where: 1) the stressor is related to the Veteran’s fear of hostile military or terrorist activity; 2) a VA psychiatrist, VA psychologist, or VA-contracted psychiatrist or psychologist, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor; 3) the stressor is consistent with the places, types, and circumstances of the Veteran’s service; and 4) there is no clear and convincing evidence to the contrary. 38 C.F.R. § 3.304(f)(3). Fear of hostile military or terrorist activity is defined as occurring when a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. After a review of all the evidence, the Board finds that the Veteran’s account of being in combat in Iraq to be credible and consistent with the circumstances of his service. The Veteran’s DD Form 214 and military personnel records confirm that that the Veteran was deployed to AOR CENTCOM (U.S. Central Command area of responsibility, covering 20 nations including Iraq and Kuwait) in support of Operation Enduring Freedom. He had nearly four months of foreign service, and he was assigned to a field artillery (FA) battalion. His primary specialty was noted to be information systems operator, and he also completed a course in nuclear biological chemical warfare. The claimed in-service stressors are consistent with the places, types, and circumstances of service. The Veteran’s claimed in-service stressors are related to the threatened death or injury of himself and others from hostile military activity and his response to these events involved a psychological state of fear and helplessness. The question for the Board is whether the Veteran has a current diagnosis of PTSD that is related to the in-service stressor event. There is evidence that the Veteran has a current diagnosis of PTSD. In November 2014, a private physician, Dr. J.T., completed a PTSD DBQ. She diagnosed the Veteran with symptoms that met the DSM criteria for a diagnosis of chronic PTSD. His symptoms included depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, panic attacks that in the past had occurred more than once a week, chronic sleep impairment, impairment of short and long term memory, flattened affect, circumstantial speech, speech intermittently illogical or obscure, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work, inability to establish and maintain effective relationships, intermittent suicidal ideation, and persistent delusions or hallucinations. Dr. J.T. noted that the Veteran had moved to Tonga after years of chronic and multiple bouts of acute distress, and he lived alone with dogs in a very remote part of a remote archipelago. In December 2020, the Veteran had a PTSD evaluation, completed through VA QTC Services. The Veteran reported having ongoing PTSD and depressive/anxiety symptoms that had been present for the last 17 years, including multiple weekly panic-related episodes and a history of suicidal ideation. He stated that during deployment to Iraq, he was involved in the initial invasion and worked as a chemical/biological warfare specialist on deployment. He experienced a missile launcher malfunctioning with the missile being released less than 50 years from his location, being exposed to indirect fire, and the treat of mortal injury on multiple occasions. After administering a Patient Health Questionnaire, Generalized Anxiety Disorder scale, and PTSD checklist, and conducting an interview with the Veteran, the examining psychologist diagnosed PTSD and somatic symptom disorder, primarily pain, with depressive/anxiety symptoms. The Veteran’s symptoms included depressed mood, anxiety, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances including work or a work like setting. The examiner opined that the Veteran’s PTSD was more likely than not incurred in or caused by the traumatic experiences he was exposed to during service. There is also evidence that the Veteran does not have a diagnosis of PTSD. In a May 2012 VA PTSD examination, the examining psychologist found that the Veteran did not meet the criteria for a diagnosis of PTSD because his claimed stressor of “an overwhelming lack of knowledge about our area of operation and potential exposure to chemicals in the air” did not meet Criterion A, as it was not related to fear of hostile military or terrorist activity. The examiner noted that the Veteran had a diagnosis of generalized anxiety disorder, which was less likely as not incurred in or caused by service; rather, it was related to life stressors after leaving the military. The Board finds that all three medical reports have at least some probative value. The two VA examiners were rendered by licensed psychologists and were based on physical examination of the Veteran, including conducting clinical testing, and both opinions include at least some rationale. Dr. J.T.’s opinion was rendered after personally treating the Veteran as a general practitioner, noting that the Veteran was a regular patient. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). The Board also finds that the Veteran’s statements regarding his in-service stressors and symptoms have been consistent. The Veteran is competent to describe observable symptoms of PTSD, and he can also report incidents in service that he experienced. The Veteran’s statements have also been consistent with the circumstances of his service, as noted above. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Under the “benefit-of-the- doubt” rule, where there exists “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet. App. 52, 59 (1993). In this case, the Board finds that there is at least “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.” As such, this is a situation where the benefit of the doubt rule applies. Ashley, 6 Vet. App. at 59; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection for PTSD is warranted. The Board also finds that entitlement to service connection for separate ratings for bruxism and enlarged tori, as secondary to the service-connected PTSD, are warranted. In a scars DBQ and an oral and dental conditions DBQ, Dr. J.T. indicated that the Veteran had psychogenic bruxism that was secondary to his PTSD, and he had enlarged tori that were secondary to the bruxism. In the January 2021 Board hearing, the Veteran testified that his tori, which are under the tongue, started growing after he returned from deployment. Various dentists told him that it could be from clenching his jaw at night, which could be a symptom of being around the explosions and things in service. He also had cracked teeth. As noted above, the Board finds Dr. J.T.’s opinion to be of at least some probative value. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claims. Specifically, Dr. J.T. does not specialize in psychiatric disorders or oral/dental diagnoses. As such, another medical opinion could be obtained. However, the Board finds that there is at least “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.” Ashley v. Brown, 6 Vet. App. 52, 59 (1993). As such, this is a situation where the benefit of the doubt rule applies. In resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection for bruxism and enlarged tori as secondary to service-connected PTSD, is warranted. 35. Service connection for tinnitus. The Veteran contends that over the course of his military career, he was exposed to loud noises, including from armored vehicles, cargo planes and trucks, helicopters, jets, passenger planes, track vehicles, tractor trailers, artillery, explosives, grenades, airplane hangars, and other sources. He was issued hearing protection, but they were poor quality, fit poorly, and he had to frequently remove them to effectively communicate with others. The Veteran stated that he constantly had a high pitched ringing, buzzing, hissing, and whistling in both ears. The Veteran is competent to describe being exposed to loud noise, such as those caused by artillery and weaponry. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). The Veteran’s lay statements are found to be credible because they have been consistent and are confirmed by the circumstances of his service. As discussed above, the Veteran had service in Southwest Asia, and he was assigned to a field artillery battalion. For these reasons, the in-service injury of acoustic trauma to both ears is established. The Board finds the Veteran’s statements to be competent and credible. He is competent to describe observable symptoms such as having a ringing or noise in the ears. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App. 370, 374-75 (2002). The Veteran’s lay statements are found to be generally credible because they are confirmed by the circumstances of his service. In addition, the Veteran submitted a medical opinion by a private nurse practitioner, G.U., in which she found that he had a current diagnosis of tinnitus that was at least as likely as not due to or related to military acoustic trauma during his active duty service. In formulating her opinion, G.U. reviewed at least some of the Veteran’s STRs, including a service enlistment examination, and a review of the medical literature, including a study that found that noise exposure experienced by military personnel exceeds that of maximum protection achievable without double hearing protection. The Board finds G.U.’s opinion to be of at least some probative value. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). The opinion was offered after a review of at least some of the Veteran’s STRs and statements, as well as a review of the medical literature. As such, the Board finds the evidence is at least in relative equipoise as to whether the current tinnitus is as likely as not due to the Veteran’s exposure to excessive noise levels in active service. See 38 C.F.R. §§ 3.303(b), 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). In resolving all reasonable doubt in the Veteran’s favor, service connection for tinnitus is warranted. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran was denied entitlement to service connection for bilateral hearing loss in the August 2016 rating decision on the basis that evidence did not show hearing loss that constituted a disability for VA purposes. In the January 2021 Board hearing, however, the Veteran indicated that his hearing had worsened since the last time he had a hearing test. As such, the Veteran should be afforded a VA examination to determine the nature and etiology of any diagnosed hearing loss. 2. Entitlement to an increased rating for the back disability is remanded. In the January 2021 Board hearing, the Veteran testified that his back disability has worsened since the last examination. Specifically, the Veteran was most recently provided a VA examination of the low back in May 2012, nearly nine years ago. The Veteran testified in the Board hearing that his back pain was more constant and was not hit-and-miss pain like it used to be. Pain restricted his range of motion and doing things such as bending over, sitting in chairs, and tying shoes caused a lot of strain and made him more uncomfortable. Thus, due to evidence of worsening symptomatology, the Board finds that a new VA examination is necessary. In addition, remand is also necessary to comply with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016). In Correia, the Court held that to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of 38 C.F.R. § 4.59. That final sentence of 38 C.F.R. § 4.59 directs that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. The Veteran had a VA back examination in May 2012, which was conducted prior to Correia, and thus did not include necessary findings. As such, remand is necessary to afford the Veteran a VA examination that complies with the Correia requirements. The examiner should also determine whether it is possible to provide a retrospective medical opinion. See Chotta v. Peake, 22 Vet. App. 80 (2008) (when there is an absence of medical evidence during a certain period of time, a retroactive medical evaluation may be warranted). 3. Entitlement to an increased rating for the right shoulder disability is remanded. The Veteran was most recently afforded a VA right shoulder examination in July 2018. However, the findings are not in compliance with Correia. As such, remand is necessary to afford the Veteran a VA examination that complies with the Correia requirements. The examiner should also determine whether it is possible to provide a retrospective medical opinion. See Chotta v. Peake, 22 Vet. App. 80 (2008) (when there is an absence of medical evidence during a certain period of time, a retroactive medical evaluation may be warranted). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and likely etiology of any current hearing loss disability. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. All indicated studies, tests, and evaluations deemed necessary should be performed. The examiner should provide a medical opinion on whether it is as likely as not (50 percent or greater probability) that any hearing loss is related to service. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 2. Schedule the Veteran for VA back and right shoulder examinations to ascertain the severity and manifestations of his service-connected back disability and right shoulder disability. The examiner is asked to review all relevant records and conduct a clinical evaluation. All indicated studies, tests, and evaluations deemed necessary should be performed. Based on this review, the examiner is asked to provide an assessment of the current nature of the Veteran’s back and right shoulder disabilities. Ranges of motion (ROM) should be tested actively and passively, in weight-bearing and nonweight-bearing, and after repetitive use. The examiner should consider whether there is likely to be additional range of motion loss due to any of the following: (1) during flare-ups; and, (2) as a result of pain, weakness, fatigability, or incoordination. If so, the examiner is asked to describe the additional loss, in degrees, if possible. The examiner should also comment on whether ROM measurements for active motion, passive motion, weight-bearing, and nonweight-bearing can be estimated for the period prior to the examination. If the examiner is unable to provide a retrospective opinion as to these specific ROM findings, he or she should clearly explain so in the report. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Nelson 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.