Citation Nr: 21012923 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 19-28 826 DATE: March 8, 2021 ORDER The application to reopen the previously denied claim of service connection for lumbar disability is granted. The application to reopen the previously denied claim of service connection for heart disability is granted. Service connection for bilateral hearing loss disability is granted. Service connection for left arm disability is denied. Service connection for neck disability is denied. Service connection for residuals of fractured pelvis is denied. Service connection for left knee disability is denied. Service connection for leg length discrepancy is denied. Service connection for hypertension is denied. Service connection for sexual disability, to include erectile dysfunction, is denied. A disability rating greater than 10 percent for tinnitus is denied. A rating greater than 30 percent for residuals of left foot surgery is denied. A compensable rating for scar residual of left foot surgery is denied. An effective date earlier than January 11, 2013, for award of service connection for tinnitus is denied. An effective date earlier than March 7, 2014, for award of service connection for residuals of left foot surgery is denied. An effective date earlier than March 7, 2014, for award of service connection for scar residual of left foot surgery is denied. An effective date earlier than March 7, 2014, for award of service connection for tinea versicolor is denied. An effective date earlier than October 8, 2014, for award of service connection for headaches is denied. REMANDED Entitlement to service connection for lumbar disability is remanded. Entitlement to service connection for heart disability is remanded. Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD) and unspecified depressive disorder is remanded. Entitlement to a compensable rating for tinea versicolor is remanded. Entitlement to a compensable rating for headaches is remanded. Entitlement to a finding of total disability based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. In a November 1985 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for lumbar disability based on the absence of ea current chronic disability. Additional evidence submitted since then relates to an unestablished fact necessary to substantiate the claims. 2. In a November 1985 rating decision, the AOJ denied service connection for heart disability based on the absence of a current chronic disability. Additional evidence submitted since then relates to an unestablished fact necessary to substantiate the claim. 3. Bilateral hearing loss disability is attributable to service. 4. Left arm disability was not manifest during active service, and is not attributable to service. 5. Neck disability was not manifest during active service, and is not attributable to service. 6. Residuals of fractured pelvis were not manifest during active service, and are not attributable to service. 7. Left knee disability was not manifest during active service, and is not attributable to service. 8. A leg length discrepancy was not manifest during active service, and is not attributable to service. 9. Hypertension was not manifest during active service, and is not attributable to service. 10. Sexual disability, to include erectile dysfunction, was not manifest during active service and is not attributable to service. 11. The current 10 percent disability rating for tinnitus is the maximum schedular rating, whether the sound is perceived in one ear or both ears; there are no unaccounted for symptoms. 12. Throughout the rating period, residuals of left foot surgery have been manifested by complaints of pain on standing and walking, flareups of pain, and functional loss due to pain. Loss of use of left foot is not demonstrated. 13. Scar residual of left foot surgery is manifested primarily by a linear scar that is barely evident; the scar is neither painful nor unstable. 14. On January 11, 2013, VA received the claim for service connection for tinnitus. There was no pending claim prior to January 11, 2013, pursuant to which service connection for tinnitus could have been awarded. 15. The Veteran did not appeal the denial of service connection for his left foot injury within one year of notice of the AOJ’s November 1985 decision. On March 7, 2014, VA received a reopened claim for service connection for left foot condition, to include scar sensitivity. 16. There was no pending claim prior to March 7, 2014, pursuant to which service connection for residuals of left foot surgery and for scar residual of left foot surgery could have been awarded. 17. On March 7, 2014, VA received the claim for service connection for tinea versicolor. There was no pending claim prior to March 7, 2014, pursuant to which service connection for tinea versicolor could have been awarded. 18. On October 8, 2014, VA received the claim for service connection for headaches. There was no pending claim prior to October 8, 2014, pursuant to which service connection for headaches could have been awarded. CONCLUSIONS OF LAW 1. The November 1985 rating decision denying claims for service connection for lumbar and heart disabilities is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. Evidence submitted since then is new and material; and the claims for service connection for lumbar disability and for heart disability are reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. Bilateral hearing loss disability was incurred in wartime service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. Left arm disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. Neck disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. Residuals of fractured pelvis were not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. Left knee disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. Leg length discrepancy was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. Hypertension was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. Sexual disability, to include erectile dysfunction, was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The claim for a separate schedular 10 percent rating for tinnitus in each ear is without legal merit. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.87, Diagnostic Code 6260. 12. The criteria for a disability rating greater than 30 percent for residuals of left foot surgery are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.44, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 13. The criteria for a compensable disability rating for scar residual of left foot surgery are not met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.20, 4.118, Diagnostic Codes 7801, 7802, 7804, 7805. 14. The criteria for an effective date earlier than January 11, 2013, for service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 5110; 38 C.F.R. § 3.400. 15. The criteria for an effective date earlier than March 7, 2014, for service connection for residuals of left foot surgery are not met. 38 U.S.C. §§ 1110, 5110; 38 C.F.R. § 3.400. 16. The criteria for an effective date earlier than March 7, 2014, for service connection for scar residual of left foot surgery are not met. 38 U.S.C. §§ 1110, 5110; 38 C.F.R. § 3.400. 17. The criteria for an effective date earlier than March 7, 2014, for service connection for tinea versicolor are not met. 38 U.S.C. §§ 1110, 5110; 38 C.F.R. § 3.400. 18. The criteria for an effective date earlier than October 8, 2014, for service connection for headaches are not met. 38 U.S.C. §§ 1110, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1973 to April 1975. He timely appealed these matters from February 2014 and March 2015 rating decisions. Entitlement to TDIU is inferred as part of claims for higher ratings. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran apparently was involved a motor vehicle accident, wrecking his motorcycle, shortly after service; he required hospitalization and treatment for approximately nine months. On his claim for service connection submitted in January 2013, the Veteran reported disabilities of the neck, leg, back, and arm that began in 1976; and reported receiving treatment for such disabilities at the University Hospital in Baltimore, Maryland. He also reported receiving treatment since January 1977 at the VA medical center in Elsmere, Delaware. In November 2013, VA specifically requested that the Veteran submit any treatment records related to his claimed disabilities; and invited the Veteran to complete releases should he desire VA to obtain such records on his behalf. There has been no response. VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). In this case, all available records identified by the Veteran as relating to claims decided below were obtained, to the extent possible. Regarding reopening of previously denied claims, the Veteran is not entitled to examination prior to submission of new and material evidence. Examination reports and opinions are thorough and adequate for the Board to render the following decisions in the Veteran’s appeal. 38 U.S.C. § 5103A(a)(2). Where there is neither evidence of pertinent disability in active service, nor competent medical evidence suggesting a relationship between current disabilities and active service, VA has no duty to provide further VA examination or obtain medical opinions, even under the low threshold of McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Reopening VA may reopen and review claims that have been previously denied if new and material evidence is submitted by or on behalf of the Veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). “New evidence” is existing evidence not previously submitted; “material evidence” is existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claims. The AOJ originally denied service connection for lumbar disability and for heart disability in November 1985 based on the absence of evidence showing current chronic disabilities. In January 2013, the Veteran submitted claims to reopen and provided details regarding his current difficulties of enlarged heart and of lumbar problems which required surgery in July 2012. There are numerous records showing longstanding low back pain, as well as current findings of degenerative changes of spine and lumbar disc herniation. There are also findings of tachycardia, and the Veteran currently took medication for heart condition. Given the presumed credibility, the additional evidence, in connection with evidence previously assembled, contributes a more complete picture to the Veteran’s claims; and is both new and material because it raises a reasonable possibility of substantiating the claims. Reopening of the previously denied claims is appropriate. Service Connection Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Some chronic diseases, such as sensorineural hearing loss (as organic disease of the nervous system), arthritis, psychosis, hypertension, cardiovascular-renal disease, and myocarditis, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). The applicable presumptive period is one year from separation. 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. When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). In this case, the Veteran was presumed sound at service entry. Clinical evaluation at entry in June 1973 was normal, and no disability other than tinea versicolor was recorded. Nor is there medical evidence of any disability prior to active service. The Board is within its province to make a determination as to whether the evidence supports a finding of service incurrence. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Bilateral Hearing Loss The Veteran contends that service connection for bilateral hearing loss disability is warranted on the basis that he was exposed to acoustic trauma in active service. His DD Form 214 reflects the Veteran’s primary specialty as a cannon crewmember in basic field artillery. Additionally, in granting service connection for tinnitus, the AOJ recognized in-service acoustic trauma from noise exposure. A December 2013 VA examination report confirms the presence of a hearing loss disability for VA purposes under 38 C.F.R. § 3.385. The remaining question, then, involves a nexus between the acoustic trauma and current disability. Service treatment records show that audiometric testing was done at entry in June 1973. The Veteran neither reported hearing loss at entry nor reported hearing loss at separation. He did undergo audiometric testing at entry and at separation from active service, showing increased puretone thresholds at the time of separation. They did not, however, meet the criteria for a current hearing loss disability for VA purposes. There is no showing of a bilateral hearing loss disability in active service or within the first post-service year. To the extent that the Veteran reports that he was exposed to excessive noise during service, such information is supported by the record and is credible. The December 2013 VA examiner opined that service connection for bilateral hearing loss disability was not warranted taking note of normal hearing at separation, despite noting a permanent positive threshold shift (worse than reference threshold). However, even though disabling hearing loss is not demonstrated at separation, a Veteran may still establish service connection for a current hearing disability by submitting evidence that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). As the rationale for the medical opinion relies solely on the normal separation findings, it lacks probative value. The record reflects noise exposure in service, sufficient to cause damage to the ears. Tinnitus is already service-connected, and puretone thresholds increased over the course of service. The sole negative opinion of record lacks probative value. Therefore the evidence establishes that the current disability began in service, with the acoustic injury. The current hearing loss, a progressive, chronic condition, is, as a matter of law, the same as that reflected at separation. 38 C.F.R. §§ 3.303, 3.309. Left Arm As noted above, the Veteran reported disabilities of the neck, leg, back, and arm beginning post-service in 1976. He has yet to submit, or provide authorization for VA to obtain, any treatment records for disabilities resulting from a motor vehicle accident in 1976. The duty to assist in the development and the adjudication of a claim is not a one-way street. Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); Zarycki v. Brown, 6 Vet. App. 91, 100 (1993); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran’s lack of response causes the Board to draw a negative inference from his inaction, particularly as he has indicated his accident resulted in many of the claimed conditions. Private records show treatment for back pain and left shoulder pain, following an injury at work in June 1989 when the Veteran attempted to close the door of a tractor trailer. VA records show “no arm pain” in August 2019 and no swelling in arms in December 2019. In August 2000, the Veteran reported a history of car accident in 1976, in which he sustained fractures of left hip and left elbow; and reported that he now had a pin on his left elbow. He complained of left shoulder and neck pain for two weeks in November 2000. Specifically, he jammed his shoulder in windshield of tractor trailer, after having pumpkin thrown at truck; and began seeing a chiropractor, with little relief noted. The Veteran now felt some numbness and tingling to arm and shoulder. In September 2020, the Veteran’s daughter reported that the Veteran had “pins and needles” in his arms, legs, and feet. His service treatment records do not reflect any findings or complaints of left arm disability, nor is there evidence of trauma or injury to the Veteran’s left arm. Clinical evaluation of the Veteran’s upper extremities was normal at separation examination from active service in April 1975. The Veteran has not since reported in the context of his claim that he experienced any left arm disability in service. Here, the in-service element has not been met. Nor is there evidence of arthritis of left arm within the first year after service. To date, the Veteran submitted no evidence or information linking active service to the currently manifested numbness and tingling of left arm. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Here, post-service records show the onset of disability well after service. The first credible showing of pertinent disability is not within a period of active service, and no presumptive provisions are applicable. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). As there is no evidence to support any finding of a nexus between service and any current left arm disability, entitlement to the benefit sought is not warranted. Neck As noted above, the Veteran reported disabilities of the neck, leg, back, and arm beginning post-service in 1976. He has yet to submit, or provide authorization for VA to obtain, any treatment records for disabilities resulting from a motor vehicle accident in 1976. The duty to assist in the development and the adjudication of a claim is not a one-way street. Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); Zarycki v. Brown, 6 Vet. App. 91, 100 (1993); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran’s lack of response causes the Board to draw a negative inference from his inaction, particularly as he has indicated his accident resulted in many of the claimed conditions. VA records show that the Veteran was hospitalized for a mass in left neck in June 1985, and he underwent a left thyroid lobectomy. As noted above, he complained of left shoulder and neck pain for two weeks in November 2000, when he jammed his shoulder in windshield of tractor trailer, after a pumpkin was thrown at truck. A biopsy of right thyroid mass was negative for malignant cells in November 2010. He had a mild sore throat in June 2012, and computed tomography of neck was done to follow-up on non-specific bilateral lymph nodes. There also was an assessment of cervical disk herniation in September 2013. The Veteran underwent a right thyroidectomy and parathyroidectomy in February 2020. Private records, received in September 2020, reveals a history of motorcycle accident in 1976 with back and pelvic issues. The Veteran’s service treatment records do not reflect any findings or complaints of neck disability, nor is there evidence of trauma or injury to the neck. There is a notation of disorder in neck in April 1974, and a throat culture was obtained. Clinical evaluation of the Veteran’s head, face, neck, and scalp was normal at separation examination from active service in April 1975. The Veteran has not since reported in the context of his claim that he experienced neck pain or neck disability in service. Here, again, the in-service element has not been met. Nor is there evidence of arthritis of cervical spine within the first year after service. Degenerative changes of spine first were noted decades after service. In this regard, a continuity of symptomatology of arthritis of cervical spine is not established. Walker, 708 F.3d at 1338-39. To date, the Veteran submitted no evidence or information linking active service to the currently diagnosed cervical disk herniation. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. Here, post-service records show the onset of disability well after service. The first credible showing of pertinent disability is not within a period of active service, and no presumptive provisions are applicable. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current cervical disk herniation, entitlement to the benefit sought is not warranted. Fractured Pelvis Private records, dated in September 1989, show a past medical history of right leg injury in 1976 where the Veteran sustained a fractured femur and injury to knee joint. VA records, dated in June 2012, show past history of multiple surgeries of left elbow and left knee and left femur in 2006. On his claim for service connection submitted in January 2013, the Veteran reported a fractured pelvis that began post-service in 1976; and reported receiving treatment for such disability at the University Hospital in Baltimore, Maryland. He also reported receiving treatment since January 1977 at a VA medical center in Elsmere, Delaware. As noted above, VA requested that the Veteran submit any treatment records related to his claimed disability or submit a completed VA Form 21-4142 for VA to obtain such records on his behalf. The Veteran neither submitted records nor authorized VA to obtain such records. In July 2019, the Veteran reported a motor vehicle accident in the 1970’s where he fractured his left knee as well as injured his pelvis. He now requested a motorized scooter for improved community mobility. He had difficulty walking distances secondary to chronic back pain, pelvic pain, bilateral hip pain, and left knee pain. The Veteran’s service treatment records do not reflect any findings or complaints of pelvic fracture or residuals, nor is there evidence of trauma or injury to the pelvis. Clinical evaluation of the Veteran’s spine and lower extremities was normal at separation examination from active service in March 1975. The Veteran has not since reported in the context of his claim that he experienced any pelvic fracture or pelvic pain in service. Here, the in-service element has not been met. To date, the Veteran submitted no evidence or information linking active service to current pelvic pain. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. No medical professional has indicated even a possible link between current disability and active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current pelvic pain, entitlement to the benefit sought is not warranted. Left Knee Private records, dated in September 1989, show a past medical history of right leg injury in 1976 where the Veteran sustained a fractured femur and injury to knee joint. In September 1989, the Veteran reported problems with his left lower extremity. Specifically, he noted increasing stiffness and difficulty with his left leg over the past six-to-eight months. Following an accident in June 1989, he noticed more and more left lower extremity pain. VA records, dated in June 2012, show past history of multiple surgeries of left elbow and left knee and left femur in 2006. On his claim for service connection submitted in January 2013, the Veteran reported an auto accident in 1976 where he fractured his pelvis and one leg was shorter than other. He also reported his “left knee gone.” In October 2013, the Veteran reported that he has had MRI scans since the motor vehicle accident and related surgeries in 1976, which involved pins and screws to left elbow and knee. He failed to report for X-rays of his left knee in November 2013. VA records, dated in July 2019, show that the Veteran requested a motorized scooter for improving community mobility. He was status-post motor vehicle accident in the 1970’s and had fractured his left knee as well as injured his pelvis at the time. He underwent left knee open reduction internal fixation at the time; and had old pins in his left knee, status-post motor vehicle accident. He was assessed with bilateral knee pain in December 2019, and had reportedly reinjured his left leg and knee in November 2019. His service treatment records do not reflect any findings or complaints of left knee disability, nor is there evidence of trauma or injury to the Veteran’s left knee. Clinical evaluation of the Veteran’s lower extremities was normal at separation examination from active service in April 1975. The Veteran has not since reported in the context of his claim that he experienced left knee disability in service. Here, the in-service element has not been met. Nor is there evidence of arthritis of left knee within the first year after service. To date, the Veteran submitted no evidence or information linking active service to the currently diagnosed left knee pain. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. The first credible showing of pertinent disability is not within a period of active service, and no presumptive provisions are applicable. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and any current left knee disability, entitlement to the benefit sought is not warranted. Leg Length Discrepancy In June 1985, the Veteran reported a left leg problem. As noted above, in January 2013, the Veteran reported disabilities of the neck, leg, back, and arm beginning post-service in 1976. He reported a motor vehicle accident in 1976, a fractured pelvis, and one leg shorter than the other. He has yet to submit, or provide authorization for VA to obtain, any treatment records for disabilities resulting from a motor vehicle accident in 1976. Private records, dated in September 1989, show a past medical history of right leg injury in 1976 where the Veteran sustained a fractured femur and injury to knee joint. He reported problems with his left lower extremity in September 1989. VA records, dated in February 2002, show that the Veteran had a history of leg length discrepancy due to hip surgery. He walked with slight limp on the left, and in tiptoe on left foot. The impression at the time was status-post hip surgery causing discrepancy in length of legs, and indicated that Veteran had chronic pain. In April 2002, the Veteran presented for evaluation and treatment of unequal limb length due to accident. He reported a 4-centimeter limb length inequality with left shorter than right, and reported that he walked on “tip toes.” He tried putting a lift in shoe, which was uncomfortable and unwearable. The assessment was leg length discrepancy due to trauma. In June 2012, a VA physician noted limp secondary to shortening of left lower extremity following surgery of left femur in 2006. In April 2014, the Veteran reported a limb length discrepancy since motor vehicle accident in 1976. The left limb had fixed equinus, which required approximately 4-centimeter lift in left shoe. In July 2019, the Veteran reported a motor vehicle accident in the 1970’s where he fractured his left knee as well as injured his pelvis. He now requested a motorized scooter for improved community mobility. He has significant leg length discrepancy as the left leg is shorter than the right leg. The Veteran’s service treatment records do not reflect any findings or complaints of leg length discrepancy, nor is there evidence of trauma or injury to either leg. Clinical evaluation of the Veteran’s lower extremities was normal at separation examination from active service in March 1975. The Veteran has not since reported in the context of his claim that he experienced any incident resulting in leg length discrepancy in service. Here, the in-service element has not been met. To date, the Veteran submitted no evidence or information linking active service to current leg length discrepancy. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. No medical professional has indicated even a possible link between current disability and active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current leg length discrepancy, entitlement to the benefit sought is not warranted. Hypertension The Veteran’s blood pressure reading was 154/100 in September 2000. VA records first show an assessment of hypertension as uncontrolled in July 2001 and as stable in 2012, and was well controlled in 2013. Systemic hypertension was assessed in October 2013. The Veteran’s service treatment records do not reflect any findings or complaints of elevated blood pressure or hypertension. Blood pressure readings were 120/78 and 100/62 in April 1974. On a "Report of Medical History" completed by the Veteran in March 1975, he checked “no” in response to whether he ever had or now had high or low blood pressure. No blood pressure reading was recorded at the Veteran’s separation examination. Clinical evaluation of the Veteran’s heart and vascular system was normal at separation examination from active service in April 1975. Here, again, the in-service element has not been met. Nor is there evidence of hypertension manifested to a degree of 10 percent or more disabling within the first year after service. Hypertension first was noted decades after service. In this regard, a continuity of symptomatology of hypertension is not established. Walker, 708 F.3d at 1338-39. To date, the Veteran submitted no evidence or information linking active service to the currently diagnosed hypertension. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. Here, post-service records show the onset of disability well after service. The first credible showing of pertinent disability is not within a period of active service, and no presumptive provisions are applicable. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current hypertension, entitlement to the benefit sought is not warranted. Sexual Disability The Veteran reported that his sex drive was markedly decreased in September 2013, after taking certain medication for hypertension. VA records, dated in November 2013, show that the Veteran took medication for erectile dysfunction. The Veteran’s service treatment records do not reflect any findings or complaints of sexual disability or erectile dysfunction. He was treated for testicle and groin pain in April 1974. Testicles at the time were within normal limits; there was tenderness to epididymis, and scrotal support was provided. Prostate was neither baggy nor tender in August 1974. The Veteran again complained of testicular pain in October 1974, and was treated for urethral discharge of three months’ duration in January 1975. Clinical evaluation of the Veteran’s genitourinary system was normal at separation examination from active service in March 1975. The Veteran has not since reported in the context of his claim that he experienced sexual disability, to include erectile dysfunction, in service. Here, the in-service element has not been met. To date, the Veteran submitted no evidence or information linking active service to current erectile dysfunction. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. No medical professional has indicated even a possible link between current disability and active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current erectile dysfunction, entitlement to the benefit sought is not warranted. Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, and 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. If feasible, these determinations are to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. Moreover, joint testing is to be conducted on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 170 (2016). Tinnitus Tinnitus is defined as “a noise in the ears such as ringing, buzzing, roaring, or clicking.” Smith v. Principi, 17 Vet. App. 168, 170 (2003) (quoting Dorland’s Illustrated Medical Dictionary 1714 (28th ed. 1994)). The Court has specifically held that tinnitus is a type of disorder capable of lay observation and description. Charles v. Principi, 16 Vet. App. 370, 374 (2002). The AOJ has evaluated the Veteran’s tinnitus as 10 percent disabling under 38 C.F.R. § 4.87, Diagnostic Code 6260, which is the maximum schedular rating. The criteria were revised effective June 13, 2003, to clarify existing VA practice that only a single 10 percent evaluation is assigned for “recurrent” tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2). Note (1) to Diagnostic Code 6260 provides that a separate rating for tinnitus may be combined with a rating under Diagnostic Codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports a rating under one of those Diagnostic Codes. Note (3) also provides that objective tinnitus (in which the sound is audible to other people and has a definable cause that may or may not be pathologic) should not be rated under Diagnostic Code 6260, but should be rated as part of any underlying condition causing the tinnitus. 38 C.F.R. § 4.87. The Veteran is competent to report symptoms of ringing in both ears. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). During a December 2013 VA examination, he reported exposure to heavy artillery for nearly three years, with fair hearing conservation. He described recurrent tinnitus as constant and progressive. In August 2020, he reported tinnitus as especially frustrating because he was unable to get away from the noise. Given that the Veteran is already in receipt of the maximum schedular rating for tinnitus, there is no basis to award a higher rating under Diagnostic Code 6260. As no exceptional circumstance or unaccounted for symptom is raised, application of an extraschedular evaluation under 38 C.F.R. § 3.321 is not appropriate. Assignment of an evaluation in excess of 10 percent for tinnitus is not warranted; the Board makes no finding regarding the appropriateness of separate compensable evaluations for those conditions now alleged as secondary to service-connected tinnitus. Residuals of Left Foot Surgery VA revised criteria for evaluation of musculoskeletal system and muscle injuries, effective February 7, 2021. 85 Fed. Reg. 76,453-76,469 (Nov. 30, 2020). No changes are applicable to Diagnostic Code 5284, pertaining to foot injuries. 38 C.F.R. § 4.71a. The Veteran’s residuals of left foot surgery have been assigned a 30 percent rating under Diagnostic Code 5284. The right foot is considered undamaged for comparison purposes. See Correia, 28 Vet. App. at 170. Pursuant to Diagnostic Code 5284, severe residuals of foot injuries warrant a 30 percent evaluation. A 40 percent evaluation requires that the residuals be so severe as to result in actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284. The term “severe” is not defined by regulation; however, the overall regulatory scheme contemplates a 30 percent rating or more in cases of ankylosis of the ankle in plantar flexion or in dorsiflexion; or where there is unilateral marked pronation or extreme tenderness of plantar surfaces of the foot with marked inward displacement and severe spasm of the tendo Achillis on manipulation; or where there is unilateral marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5276, 5277, 5278. A March 2015 VA examination report reveals the Veteran’s past surgical history for removal of glass from left foot in 1974; residuals included pain, described as sharp and jabbing. The Veteran reported flare-ups when standing or walking too long and functional loss from pain. No other foot abnormalities were noted. The examiner indicated that the severity of the Veteran’s left foot injury was severe and chronically compromised weight-bearing. A custom insert or shoe modification was required. Contributing factors of disability included pain on movement, pain on weight-bearing, disturbance of locomotion, and interference with standing; and such factors significantly limited functional ability during flare-ups. Diagnostic testing revealed arthritis and hypertrophy. The right foot was not painful on physical examination. Recent VA records show assessments of left foot pain in 2019 and in 2020. Here, throughout the appeal, the Veteran has consistently reported left foot pain. The August 2015 examiner noted limitations with standing and walking, as well as functional loss due to left foot pain. The objective evidence does not support a disability rating greater than 30 percent for residuals of left foot surgery. The evidence reveals a long history of left foot pain; however, the August 2015 examiner described residuals of left foot surgery as severe. Even when taking into account the Veteran’s lay assertions in terms of flare-ups when standing or walking too long, such reports of functional loss resulting from pain are already contemplated by the currently assigned 30 percent rating. However, the evidence does not reveal actual loss of use of left foot to warrant a higher rating. In this regard the evidence is not in equipoise but is against a disability rating greater than 30 percent for residuals of left foot surgery. The Board ultimately places more weight on results of objective clinical examination than the Veteran’s lay reports as to severity of his symptoms. Hence, staged ratings are not applicable. The Board also considered whether residuals of left foot surgery should be rated under other diagnostic codes pertaining to foot disabilities. However, in this case, his disability picture squarely fits within the criteria set forth for a 30 percent evaluation under Diagnostic Code 5284. No other diagnostic codes are applicable. Scar Residual of Left Foot Surgery Here, the AOJ has evaluated the Veteran’s scar residual of left foot surgery as 0 percent (noncompensable) disabling under 38 C.F.R. § 4.118, Diagnostic Code 7805, pertaining to other disabling effects of scars. As noted above, a separate 30 percent rating has been assigned for residuals of left foot surgery under Diagnostic Code 5284. Manifestations of that separate rating are not for consideration in evaluating the Veteran’s scar residual of left foot surgery. Pursuant to Diagnostic Code 7805, disabling effects not considered in a rating provided under Diagnostic Codes 7800, 7801, 7802, and 7804 are to be rated under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805. Diagnostic Code 7800 pertains only to scars (including burn scars) that are located on the head, face, or neck; and is not applicable to the Veteran’s appeal. Pursuant to Diagnostic Code 7801, a scar at a location other than the head, face, or neck that is deep or that causes limitation of motion would have to have an area exceeding 6 square inches (39 square centimeters) to warrant a 10 percent rating, 12 square inches (77 square centimeters) to warrant a 20 percent rating, 72 square inches (465 square centimeters) to warrant a 30 percent rating, or 144 square inches (929 square centimeters) to warrant a 40 percent rating. 38 C.F.R. § 4.118, Diagnostic Code 7801. A deep scar is one that is associated with underlying soft tissue damage. See 38 C.F.R. § 4.118, Diagnostic Code 7801, Note (1). Pursuant to Diagnostic Code 7802, a scar at a location other than the head, face, or neck that is superficial and that does not cause limitation of motion would have to have an area exceeding 144 square inches (929 square centimeters) to warrant a 10 percent rating. 38 C.F.R. § 4.118, Diagnostic Code 7802. A superficial scar is one that is not associated with underlying soft tissue damage. See 38 C.F.R. § 4.118, Diagnostic Code 7802, Note (1). Pursuant to Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating; three or four scars that are unstable or painful warrant a 20 percent rating; and five or more scars that are unstable or painful warrant a 30 percent rating. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1). Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (3). Here, the objective evidence does not support a compensable disability rating on the basis of scars. Historically, the Veteran was treated in active service for an infected ulcer on plantar surface of left foot in June 1974; surgery was conducted for removal of glass in left foot. During the March 2015 VA examination, the Veteran reported that he stepped on glass that penetrated through the boot and required surgical extraction. The scar was now barely evident. The March 2015 examiner noted that a scar on the anterior plantar surface of left foot was linear and measured 1.5 centimeters; the scar was neither painful nor unstable. There were no other pertinent findings, and the scar did not impact the Veteran’s ability to work. In this case, the objective evidence reflects that the Veteran’s service-connected scar residual of left foot surgery has been manifested primarily by a linear scar of less than 929 square centimeters; and that the scar is neither painful nor unstable. Solely on the basis of this one scar, the evidence does not meet the criteria for a compensable disability rating under Diagnostic Codes 7801 or 7802 or 7804. No examiner has indicated that the scar is deep, or that it is poorly nourished with repeated ulcerations or unstable. Loss of function of body part affected has been separately rated; no other diagnostic codes are applicable. Thus, the evidence is against the grant of a compensable disability rating for scar residual of left foot surgery. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. Effective Date of Awards of Service Connection The effective date for a grant of service connection is the day following the date of separation from active service or the date entitlement arose, if the claim is received within one year after separation from service. Otherwise, it is the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a), (b); 38 C.F.R. § 3.400(b). The effective date of service connection based on a reopened claim is the date of receipt of the new claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). Although a claimant need not identify the benefit sought “with specificity,” see Servello v. Derwinski, 3 Vet. App. 196, 199-200 (1992), some intent on the part of the Veteran to seek benefits must be demonstrated. See Brannon v. West, 12 Vet. App. 32, 34-35 (1998). See also Talbert v. Brown, 7 Vet. App. 352, 356-7 (1995) (noting that while VA must interpret a claimant’s submissions broadly, VA is not required to conjure up issues not raised by claimant). The United States Court of Appeals for the Federal Circuit has emphasized VA has a duty to fully and sympathetically develop a Veteran’s claim to its optimum. Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998). This duty requires VA to “determine all potential claims raised by the evidence, applying all relevant laws and regulations,” Roberson v. West, 251 F.3d 1378, 1384 (Fed. Cir. 2001), and extends to giving a sympathetic reading to all pro se pleadings of record. Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized formal and informal claims. See 38 C.F.R. § 3.1(p). The amendments also, inter alia, eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Tinnitus The Veteran first filed a claim for service connection for tinnitus (claimed as ringing in both ears) on January 11, 2013. He had not submitted any communication indicating an intent to apply for service connection for tinnitus prior to January 11, 2013. The evidence of record, to include private and VA treatment records, examination reports, and lay statements, provided no basis on which to infer such a claim. While a VA examiner in December 2013 has associated the Veteran’s tinnitus with acoustic trauma in active service, such evidence did not reference any previously submitted claim, formal or informal, or any intent to file a claim or seek benefits for tinnitus. Hence, there was no pending claim prior to January 11, 2013, pursuant to which benefits could be granted. Because the claim for service connection for tinnitus was received in 2013, i.e., more than one year following separation from service, as a matter of law, the effective date can be no earlier than the date of receipt of the claim. 38 C.F.R. § 3.400(b). Accordingly, the proper effective date can be no earlier than January 11, 2013. The effective date of the award of compensation for tinnitus cannot precede the effective date of the grant of service connection. The weight of the evidence is against the grant of an effective date earlier than January 11, 2013, for the award of service connection and compensation for tinnitus. Reasonable doubt does not arise, and the claim for an earlier effective date is denied. Residuals of Left Foot Surgery, and Scar Residual of Left Foot Surgery In cases involving new and material evidence, where evidence other than service department records is received within the relevant appeal period or prior to the issuance of the appellate decision, the effective date will be as though the former decision had not been rendered. 38 C.F.R. § 3.400(q)(1). In cases where the evidence is received after the final disallowance, the effective date is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2). There is no basis for a freestanding earlier effective date claim from matters addressed in a final rating decision. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). Generally, the effective date of service connection based on a reopened claim is the date of receipt of the new claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). Here, the Veteran first filed a claim for service connection for his left foot injury on June 16, 1980. In a November 1985 decision, the AOJ denied service connection primarily because there was no “line of duty determination” noted within service. VA sent notification to the Veteran later that same month. There is no indication that the mailing was returned to sender as undeliverable. On March 7, 2014, the Veteran again filed a claim for service connection for his left foot condition, to include scar sensitivity. He underwent a VA examination in March 2015. The examiner noted that the Veteran underwent a surgical procedure for removal of glass from his left foot in 1974, and that he still had pain and functional loss. Subsequently, in March 2015, the AOJ granted service connection for residuals of left foot surgery and for scar residual of left foot surgery, each effective March 7, 2014. The Veteran appealed for an earlier effective date. Specifically, the Veteran has attempted to revisit the prior final November 1985 rating decision denying service connection for his left foot injury, without alleging clear and unmistakable error. There is no basis for “freestanding” earlier effective date claims from matters addressed in a final rating decision. See Rudd v. Nicholson, 20 Vet. App. at 299-300. Once a rating decision becomes final, an earlier effective date can only be established by a request for a revision of that decision based on clear and unmistakable error. Id.; see also 38 U.S.C. § 7111; 38 C.F.R. §§ 3.105(a), 20.1400. In addition, the law is well settled that any breach of VA’s duty to assist a claimant cannot form a basis for a claim of clear and unmistakable error because such a breach creates only an incomplete rather than an incorrect record. Elkins v. Brown, 8 Vet. App. 391, 396 (1995). To the extent that the Veteran has improperly raised “freestanding” claims for earlier effective dates, those claims are dismissed. The evidence of record simply does not support a finding of any pending claim, formal or informal, prior to March 7, 2014. Between June 1980 and March 2014, no formal or informal claim, or other evidence or other communication which might be construed as an attempt to file a claim, with regard to the Veteran’s left foot injury, was received by VA. The effective date for awards of service connection on a reopened claim is the date of receipt of the claim or the date entitlement is shown, whichever is later. Here, the date of the reopened claim controls. Tinea Versicolor The Veteran first filed a claim for service connection for tinea versicolor (claimed as upper body skin condition) on March 7, 2014. He had not submitted any communication indicating an intent to apply for service connection for tinea versicolor prior to March 7, 2014. The evidence of record, to include private and VA treatment records, examination reports, and lay statements, provided no basis on which to infer such a claim. While a VA examiner in March 2015 noted a rash and tinea versicolor in active service and noted ongoing treatment, such evidence did not reference any previously submitted claim, formal or informal, or any intent to file a claim or seek benefits for tinea versicolor. Hence, there was no pending claim prior to March 7, 2014, pursuant to which benefits could be granted. Because the claim for service connection for tinea versicolor was received in 2014, i.e., more than one year following separation from service, as a matter of law, the effective date can be no earlier than the date of receipt of the claim. 38 C.F.R. § 3.400(b). Accordingly, the proper effective date can be no earlier than March 7, 2014. The weight of the evidence is against the grant of an effective date earlier than March 7, 2014, for the award of service connection and compensation for tinea versicolor. Reasonable doubt does not arise, and the claim for an earlier effective date is denied. Headaches The Veteran first filed a claim for service connection for headaches on October 8, 2014. He had not submitted any communication indicating an intent to apply for service connection for headaches prior to October 8, 2014. The evidence of record, to include private and VA treatment records, examination reports, and lay statements, provided no basis on which to infer such a claim. While a VA examiner in March 2015 noted a medical history of developing headaches after hitting head on rock and treatment with medications in service; and noted current headaches, such evidence did not reference any previously submitted claim, formal or informal, or any intent to file a claim or seek benefits for headaches. Hence, there was no pending claim prior to October 8, 2014, pursuant to which benefits could be granted. Because the claim for service connection for headaches was received in 2014, i.e., more than one year following separation from service, as a matter of law, the effective date can be no earlier than the date of receipt of the claim. 38 C.F.R. § 3.400(b). Accordingly, the proper effective date can be no earlier than October 8, 2014. The weight of the evidence is against the grant of an effective date earlier than October 8, 2014, for the award of service connection for headaches. Reasonable doubt does not arise, and the claim for an earlier effective date is denied. REASONS FOR REMAND Lumbar The Veteran contends that service connection is warranted for lumbar disability. He reported the onset of low back pain in active service. Service treatment records noted “L3 problem” for sixty days in October 1974, when Veteran received treatment for painful callus at site of glass removal. Clinical evaluation of the Veteran’s spine was normal at separation examination from active service in April 1975. The Veteran also reported disabilities of the neck, leg, back, and arm beginning post-service in 1976, following a motor vehicle accident. In June 1985, the Veteran reported that he had pulled his back in 1973. He reinjured his back in 1985 after a slip-and-fall on a concrete floor at work. Diagnosis in 1985 was acute lumbosacral strain, strained symphis pubis with separation. The Veteran continued to have persistent difficulty with lower back, and computed tomography scan in early 1986 revealed no disc herniation. The Veteran’s lumbar problems continued in 1989. Computed tomography at that time revealed a central disc herniation at L4-L5 and mild spinal stenosis at multiple levels. His back pain was persistent, with leg radiation primarily on left side. More recent records showed complaints of constant low back pain. The Veteran underwent lumbar surgery in 2012 and in 2019. Lumbar radiculopathy was diagnosed in December 2019. Consequently, a remand is required to provide the Veteran with examination or medical review in order to comply with VA’s duty to assist. McLendon, 20 Vet. App. at 83-86. Heart The Veteran contends that service connection is warranted for heart disability. He reported the onset of heart pain in active service. Service treatment records noted complaints of “heart pain” reference by the Veteran in May 1974, which lasted five-to-ten minutes. Physical examination at the time revealed regular rate and rhythm, and heart sounds were heard in all valve areas; heart was of normal size. The impression was viral syndrome. Clinical evaluation of the Veteran’s heart was normal at separation examination from active service in April 1975. In June 1985, the Veteran reported having heart problems in 1974. Tachycardia was noted in October 2010, and an irregular heart rate was noted in July 2011. In April 2013, the Veteran felt as if he were having a heart attack, which was attributed to an allergic reaction to medication. The Veteran underwent many cardiac tests in June 2013 because his heart was racing again. Diagnosis was possible panic attack. He continued taking medication for heart condition in November 2013. Myocardial stability was noted in February 2020. Consequently, a remand is required to provide the Veteran with examination or medical review in order to comply with VA’s duty to assist. McLendon, 20 Vet. App. at 83-86. Psychiatric Disability The Veteran contends that his acquired psychiatric disability, to include PTSD, had its onset in active service or within the first year after service. All screenings post-service have been negative for PTSD. On his claim for service connection submitted in January 2013, the Veteran reported that he was in a motor vehicle accident in 1976. A psychologist recently noted that the Veteran was given a hardship discharge from service in April 1975, following the death of the Veteran’s mother. The Veteran had struggled emotionally around that time and had a suicide attempt, in which he wrecked his motorcycle. Since then, the Veteran has provided conflicting statements regarding psychiatric treatment soon after service and of a suicide attempt. He is invited to submit competent lay or medical statements to corroborate any psychiatric treatment he received during the first year after service or since then. Specifically, VA records, dated in September 2013, show no psychiatric history. In November 2013, the Veteran reported receiving no treatment for PTSD. He has not submitted any statement of in-service stressors; and answered “no” in March 2015 when asked whether he had thoughts about taking his life or had ever had a suicide attempt. Subsequently, in March 2017, the Veteran was hospitalized for suicidal ideation. Diagnoses in July and August 2019 included chronic PTSD and other recurrent depressive disorders. In August 2020, a private psychologist diagnosed the Veteran with unspecified depressive disorder; and opined that it was more likely than not that the Veteran’s mental health disorder started during active service. The psychologist concluded that the Veteran encountered significant stressors in service, including poor adjustment and the death of his mother. The psychologist opined that the Veteran’s depressive disorder was more likely than not aggravated by service-connected disabilities, due to pain and limitations from residuals of foot injury and from headaches and from problems hearing. A research article regarding guilt, shame, and suicidal ideation was submitted in support of the Veteran’s claim. In September 2020, the Veteran’s wife reported knowing the Veteran ever since high school. The Veteran was fun and very social. She noticed some changes. The Veteran no longer was the jolly-type of person he had been prior to service. The Veteran became snappy, developed a temper, and was withdrawn. The Veteran’s wife reported that the Veteran “suffered a car accident in 1976 and all his mental conditions just got worse.” He became angry and stressed very easily. She also contended that the Veteran’s foot pain, tinnitus, and tinea versicolor had worsened his depression. Here, a reasonable basis for a possible nexus is raised, and examination or medical review is required; determination of proximate cause and degree of aggravation, if possible, are especially important. McLendon, 20 Vet. App. at 83-86. An examination is needed to determine whether the Veteran currently meets the criteria for a diagnosis of any acquired psychiatric disorder under DSM-5, to include based on in-service stressors or as secondary to service-connected disabilities. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4). Tinea Versicolor The Veteran has reported that his tinea versicolor affects his upper body. A full examination has not been performed since 2015, and updated findings are required. VA revised criteria for evaluation of skin disabilities, effective August 13, 2018. 83 Fed. Reg. 32,592-32,601 (July 13, 2018). The VA Secretary specifically stated an intent to apply the revised criteria to all pending claims, wherever more favorable. The revised criteria provide a distinct clarification between “systemic therapy” and “topical therapy,” and include a general rating formula for skin disabilities. Diagnostic Code 7806, pertaining to dermatitis or eczema, is to be evaluated under the General Rating Formula for the Skin. 38 C.F.R. § 4.118. Headaches The Veteran contends that a compensable rating is warranted for headaches. In September 2020, VA received correspondence from the Veteran’s daughter, which indicated that the Veteran had to lay down nearly five or six times a day in a dark and quiet room. He also complained of dizziness and became lightheaded and nauseous. A full examination has not been performed since 2015, and updated findings are required. TDIU The Veteran has raised the issue of TDIU as part and parcel of claims for higher ratings; and VA examiners have noted functional impairment resulting from service-connected disabilities. Entitlement to TDIU is inextricably intertwined with the open evaluation claims addressed in this remand section. The matters are REMANDED for the following action: 1. Request that the Veteran provide properly executed releases for any private care providers who have treated him for psychiatric disability during the first year after service or since then. Upon receipt of such, VA must take appropriate action to contact the identified providers and request complete treatment records. The Veteran should be informed that in the alternative he may obtain and submit the records himself. 2. Obtain the Veteran’s VA treatment records for the period from April 2020 to the present. 3. Schedule a VA examination to determine the nature and etiology of the Veteran’s lumbar disability. The claims file must be available and reviewed in such regard. Specifically, the examiner must opine as to whether any lumbar disability is at least as likely as not related to in-service injury or disease, including the “L3 problem” noted in service treatment records in October 1974 and a “pulled back” as alleged by the Veteran. A full and complete rationale for opinions expressed is required. 4. Schedule a VA examination to determine the nature and etiology of the Veteran’s heart disability. The claims file must be available and reviewed in such regard. Specifically, the examiner must opine as to whether any heart disability is at least as likely as not related to in-service injury or disease, including the Veteran’s complaints of “heart pain” noted in service treatment records in May 1974 and assessed as viral syndrome. A full and complete rationale for opinions expressed is required. 5. Schedule a VA mental disorders examination; the claims file must be reviewed in conjunction with examination. The examiner must identify all current psychiatric disabilities under the DSM-5 criteria. The examiner must opine as to whether any such are at least as likely as not caused or aggravated by service or service-connected disabilities, or had their onset in active service or during the first year after service. The examiner should interview the Veteran to identify any claimed in-service stressors. The research article referenced above must be discussed. A full and complete rationale for all opinions expressed is required. 6. Schedule the Veteran for a VA skin examination to assess the current status of his tinea versicolor. The examiner should specify all parts of the body affected, and provide estimates of the percentage of the entire body and exposed areas affected, as well as describe the treatment required. 7. Schedule the Veteran for a VA headaches (including migraine headaches) examination to assess the current severity of his headaches. The examiner specifically should describe the frequency, severity, and duration of headaches; and indicate whether headaches are productive of severe economic inadaptability. To the extent possible, the examiner should distinguish symptoms attributable to service-connected headaches from those of other neurological or headache-type conditions. If not medically possible to do so, the examiner should clearly so state, indicating that findings are with respect to the Veteran’s overall headaches. 8. Then, readjudicate the claims on appeal. If any benefit sought remains denied, issue an appropriate supplemental statement of the case and return the appeal to the Board. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary C. Suffoletta 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.