Citation Nr: 21022481 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-16 755 DATE: April 15, 2021 ORDER Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for right upper extremity motor impairment secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for left upper extremity motor impairment secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for right lower extremity motor impairment secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for left lower extremity motor impairment secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for motor impairment with loss of automatic movements (right facial) secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for motor impairment with loss of automatic movements (left facial) secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for constipation secondary to Parkinson’s disease is denied. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for speech changes secondary to Parkinson’s disease is denied. Entitlement to an effective date of February 11, 2015, though no earlier, is granted for the award of service connection for difficulty chewing and swallowing secondary to Parkinson’s disease. Entitlement to an effective date earlier than February 15, 2011 for the grant of SMC based on housebound status is denied. Entitlement to an effective date earlier than October 14, 2015 for the grant of service connection for loss of smell secondary to Parkinson’s disease is denied. Entitlement to an initial rating in excess of 10 percent for speech changes secondary to Parkinson’s disease is denied. Entitlement to an initial rating in excess of 10 percent for constipation secondary to Parkinson’s disease is denied. Entitlement to an initial compensable rating for loss of smell secondary to Parkinson’s disease is denied. Entitlement to an initial rating in excess of 30 percent for Parkinson’s disease with balance impairment is denied.   REMANDED Entitlement to an initial rating in excess of 30 percent for right upper extremity motor impairment as secondary to Parkinson’s disease is remanded. Entitlement to an initial rating in excess of 20 percent for left upper extremity motor impairment as secondary to Parkinson’s disease is remanded Entitlement to an initial rating in excess of 20 percent for right lower extremity motor impairment as secondary to Parkinson’s disease is remanded. Entitlement to an in initial rating in excess of 20 percent for left lower extremity motor impairment as secondary to Parkinson’s disease is remanded. Entitlement to an initial compensable rating for right facial impairment as secondary to Parkinson’s disease is remanded. Entitlement to an initial compensable rating for right facial impairment as secondary to Parkinson’s disease is remanded. Entitlement to an initial rating in excess of 30 percent for headaches as secondary to Parkinson’s disease is remanded. Entitlement to an initial compensable rating for difficulty chewing and swallowing secondary to Parkinson’s disease is remanded. FINDINGS OF FACT 1. The Veteran did not file a claim prior to February 15, 2011 of entitlement to service connection for Parkinson’s disease or its secondary complications. 2. The Veteran’s claims for service connection for dizziness and headaches were denied in a final and binding (i.e., unappealed) July 2004 rating decision, and new and material evidence was not received within one year of that decision. 3. Resolving reasonable doubt in his favor, the Veteran had difficulty chewing and swallowing as of February 15, 2011. 4. The earliest evidence of loss of smell is not until October 14, 2015. 5. Prior to February 15, 2011, the Veteran was not in receipt of service connection for more than one disability; thus, a grant of SMC on the basis of housebound dates (i.e. having at least one disability rated as 100 percent disabling, and additional disability rated as 60 percent disabling) is not possible. 6. At no time during the pendency of his claim, has the Veteran had a complete loss of sense of smell, hoarseness of his voice (to include with thickening or nodules of the cords, polyps submucous infiltration, or pre-malignant changes on biopsy), a constant inability to speak above a whisper or to communicate, and/or alternating diarrhea and constipation, with more or less constant abdominal distress. 7. The Veteran is in receipt of the maximum rating for Parkinson’s disease with imbalance. CONCLUSIONS OF LAW 1. The criteria are not met for an effective date earlier than February 15, 2011 for the grant of service connection for Parkinson’s disease, bilateral upper and lower extremity motor impairment secondary to Parkinson’s disease, bilateral motor impairment with loss of automatic movements (facial), constipation, and speech changes secondary to Parkinson’s disease. 38 U.S.C. §§ 5103 (a), 5103A, 5107(b), 5110; 38 C.F.R. § 3.400. 2. The criteria are met for an earlier effective date of February 15, 2011, though not earlier, for the grant of service connection for difficulty chewing and swallowing as secondary to Parkinson’s disease. 38 U.S.C. §§ 5103 (a), 5103A, 5107(b), 5110; 38 C.F.R. § 3.400. 3. The criteria are not met for an effective date earlier than February 15, 2011 for the grant of SMC based on housebound status. 38 U.S.C. § 1114, subsection (s) and 38 C.F.R. § 3.350(i). 4. The criteria are not met for an effective date earlier than October 14, 2015 for the grant of service connection for loss of smell secondary to Parkinson’s disease. 38 U.S.C. §§ 5103 (a), 5103A, 5107(b), 5110; 38 C.F.R. § 3.400. 5. The criteria are not met for an initial rating in excess of 10 percent for speech changes, an initial rating in excess of 10 percent for constipation, an initial compensable rating for loss of smell, and/or an initial rating in excess of 30 percent for Parkinson’s disease with balance impairment. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.87, DC 8004-6204; 4.114, DC 6399-7319; 4.87a, DC 6275; 4.87, DC 8004-62045. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Effective Dates 1. -9. Entitlement to an effective date earlier than February 15, 2011 for the grant of service connection for Parkinson’s disease, motor impairment (right upper extremity, left upper extremity, right lower extremity, left lower extremity), constipation, speech changes, and motor impairment with loss of automatic movements (right facial, left facial). Except as otherwise provided, the effective date of an evaluation and award of compensation based on a claim reopened after final disallowance, will be on the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. On February 15, 2011, VA received the Veteran’s VA Form 21-526b in which he requested service connection for Parkinson’s Disease. There is no evidence in the claims file prior to February 15, 2011 which can reasonably be found to be a claim, informal or formal, for service connection for Parkinson’s Disease or for the conditions which are secondary to it. 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. 38 C.F.R. §§ 3.151, 3.155, 3.157. The amended regulations apply to claims filed on or after March 24, 2015, which is not this Veteran’s situation. Therefore, the regulations in effect in 2011, when he filed his claim, are applicable. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 C.F.R. § 3.151. The term "claim" or "application" is used interchangeably and means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief of entitlement to a benefit. 38 C.F.R. § 3.1(p). See also Rodriguez v. West, 189 F.3d. 1352 (Fed. Cir. 1999), cert. denied, 529 U.S. 1004 (2000). The benefit sought must be identified, see Stewart v. Brown, 10 Vet. App. 15, 18 (1997), but need not be specific, see Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). That said, while VA must interpret a claimant's submissions broadly, VA is not required to conjure up issues not raised by the claimant. VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). "Date of receipt" generally means the date on which a claim, information, or evidence was received by VA. 38 C.F.R. § 3.1(r). Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such an informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year after the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). In a January 2012 rating decision, the regional office (RO), granted service connection for Parkinson’s disease and headaches associated with Parkinson’s disease, retroactively effective from February 15, 2011, the date upon which the Veteran filed his claim. The Veteran filed a notice of disagreement with the ratings assigned in the January 2012 decision and argued that separate ratings were warranted for a variety of symptoms. In a March 2016 rating decision, the RO granted service connection for bilateral upper and lower extremity motor impairment, constipation, speech changes, and bilateral facial motor impairment, all secondary to his Parkinson’s disease, and SMC; the RO retroactively assigned an effective date of February 15, 2011. Neither the Veteran nor his attorney has advocated for a specific earlier date or provided adequate rationale why a date earlier than February 15, 2011 is warranted. Nonetheless, the Board has reviewed the claims file for a possible earlier effective date, but has not found one. The Board acknowledges that in August 2003, the Veteran filed a claim for service connection for chronic dizziness, and that dizziness may, in some circumstances, be a symptom of Parkinson’s disease. However, in the Veteran’s situation, the clinical records in 2002 reflect that the Veteran reported that he had a dizzy and drunk feeling with certain medication; there is no indication that this was a claim for service connection for Parkinson’s disease. The Board also notes that in August 2003, the Veteran filed a claim for service connection for chronic headaches. At that time, the clinical records noted a diagnosis of migraine headaches. However, there is no indication that this was a claim for service connection for Parkinson’s disease. (Notably, although the Veteran was eventually granted service connection for headaches as associated with Parkinson’s disease based on a 2011 family medicine physician’s opinion, a October 2015 neurologist opinion notes that the Veteran’s headaches predated the Veteran’s Parkinson’s disease by several decades, and that there is no evidence that Parkinson’s disease causes or aggravates a migraine headache condition.) Regardless, as the Veteran did not have Parkinson’s disease in 2003, his 2003 claims for service connection for dizziness and headaches cannot be reasonably considered as a claim for service connection for Parkinson’s disease. Moreover, these claims were denied in a final unappealed July 2004 and new and material evidence was not received within one year of that denial. The earliest document which can reasonably be found as a claim for service connection for Parkinson’s disease is the Veteran’s February 2011 VA Form 21-526b. As noted above, the Veteran has numerous disabilities which are secondary to his service-connected Parkinson’s disease. The effective date for a secondarily service-connected condition is not necessarily identical to that of the original condition. See Ellington v. Nicholson, 541 F.3d 1364 (Fed. Cir. 2008). But the effective date for the secondary condition could arise no earlier than the date on which the appellant applied for benefits for the underlying condition since it precipitated (meaning caused or aggravated) the secondary condition. 38 C.F.R. § 3.310. In addition, under the former regulations, medical records cannot constitute an informal claim for benefits unless there has been a prior allowance or disallowance of a claim. See 38 C.F.R. § 3.157(b). See also MacPhee v. Nicholson, 459 F.3d 1323, 1326 (Fed. Cir. 2006). The mere presence of medical evidence, alone, does not establish intent on the part of a Veteran to seek service connection for a condition. See Brannon v. West, 12 Vet. App. 32, 35 (1998). See also Lalonde v. West, 12 Vet. App. 377, 382 (1999) (where appellant had not been granted service connection, receipt of medical records could not be construed as informal claim). Merely seeking treatment does not establish a claim, formal or informal, for service connection. In the absence of sufficient manifestation of an intent to apply for benefits for a particular disease or injury, a document providing medical information in and of itself is not an informal claim for VA benefits. See Ellington v. Nicholson, 22 Vet. App. 141 (2007). As the Veteran is in receipt of service connection for Parkinson’s disease effective from February 15, 2011, earlier effective dates for the secondary/associated disabilities are not warranted. 10. Entitlement to an effective date earlier than February 15, 2011 for the grant of special monthly compensation based on housebound status (SMC). As noted above, in a March 2016 rating decision, the RO granted SMC. SMC was awarded, effective from February 15, 2011, pursuant to 38 U.S.C. § 1114, subsection (s) and 38 C.F.R. § 3.350 (i), which allow for SMC when a Veteran has one disability rated as 100 percent disabling and additional service-connected disabilities independently ratable at 60 percent or more. In this Veteran’s situation, he had one disability (posttraumatic stress disorder with bipolar disorder) rated as 100 percent effective from February 24, 2003. He does not have any other service-connected disabilities prior to February 15, 2011. Therefore, an earlier effective date for SMC is not available. 11. Entitlement to an effective date earlier than October 14, 2015 for the grant of service connection for difficulty chewing and swallowing as secondary to Parkinson’s disease. In a March 2016 rating decision, the RO granted service connection for difficulty chewing and swallowing as secondary to Parkinson’s disease, and assigned a retroactive effective date of October 14, 2015, the date upon which the RO found that the symptom was first identified. The Board has reviewed the records and finds that an earlier effective date is warranted. A March 3, 2011 VA clinical record notes that the Veteran had a “2” in “Off” for swallowing under the United Rating Scale for Parkinsonism. The Board finds that this would equate with mild symptoms when the Veteran was four hours after taking medication. A March 10, 2011 reflects that he was positive for difficulty swallowing. An April 2011 VA contract examination report reflects that the Veteran, when listing his complaints, “reports no difficulty with swallowing”. A July 2011 neurology record reflects that the Veteran had a “2” in “Off” under the United Rating Scale for Parkinsonism; this would equate with mild symptoms when the Veteran was tested five hours after taking medication. A July 2012 record notes that the Veteran had no difficulties with swallowing. An August 2012 record notes that he reported a sore throat and pain with swallowing. An October 2015 Disability Benefits Questionnaire (DBQ) reflects that the Veteran reported mild difficulty with chewing/swallowing. Based on the foregoing, the Board finds that an effective date of February 15, 2011 is warranted for the grant of service connection for difficulty chewing or swallowing. The evidence reflects no dysphagia (difficulty swallowing) except mild difficulty swallowing pills in 2009 (prior to the rating decision on appeal), and mild difficulties or no difficulties during the pendency of his claim. Thus, the Board can reasonably find, and in giving the benefit to the Veteran, that the Veteran has had at least some dysphagia from February 15, 2011. A rating prior to February 15, 2011 is not warranted because the Veteran was not in receipt of service connection for Parkinson’s disease prior to February 15, 2011, and there is no informal or formal claim for service connection for a related disability prior to that date. Unless specifically provided otherwise, the effective date of an award based on an original claim, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Moreover, the effective date cannot predate February 15, 2011, the date upon which he is in receipt of service connection for the primary disability of Parkinson’s disease. 12. Entitlement to an effective date earlier than October 14, 2015 for the grant of service connection for loss of smell as secondary to Parkinson’s disease. In a March 2016 rating decision, the RO granted service connection for loss of sense of smell as secondary to Parkinson’s disease, and assigned a retroactive effective date of October 14, 2015. An April 2011 VA contract examination report reflects that the Veteran reported that he does not experience any smell problems. A July 2012 record notes that the Veteran had a normal sense of smell. VA clinical records in 2013 and 2014 reflect that the Veteran reported that smells trigger flashbacks of his service trauma; thus, indicating, he retained a sense of smell. An October 2015 DBQ reflects that the Veteran reported partial loss of sense of smell. Based upon the evidence in this case, the exact onset of the Veteran’s current symptom cannot be determined with any certainty. The earliest that it can be ascertained that the Veteran had a loss of some sense of smell is the October 14, 2015 DBQ. The “plain meaning of [38 C.F.R. § 3.310 ] is and has always been to require VA to afford secondarily service-connected conditions the same treatment (no more or less favorable treatment) as the underlying service-connected conditions for all determinations.” Roper v. Nicholson, 20 Vet. App. 173, 181 (2006). Building on Roper, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit Court) held that “a requirement that a secondary condition ‘be considered a part of [an] original condition’ does not, in our view, establish that the original condition and the secondary condition must receive identical effective dates.” Ellington v. Peake, 541 F.3d 1364, 1369 (Fed. Cir. 2008). “Indeed, a per se rule requiring identical effective dates for primary and secondary conditions would be illogical, given that secondary conditions may not arise until years after the onset of the original condition.” Id. The Federal Circuit Court concluded that “the effective date for secondary conditions is governed by [38 C.F.R. §] 3.400, which establishes the effective date as the ‘date of receipt of claim, or [the] date entitlement arose, whichever is later.’” Id. It explained: “[T]his result is consistent with 38 U.S.C. § 5110, the statute which governs the effective date of awards. Section 5110(a) provides generally that ‘[u]nless specifically provided otherwise in this chapter, the effective date of an award based on an original claim... shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.’ The statute contains no exception to this rule for a claim.” Id. at 1370; see Manzanares v. Shulkin, 863 F.3d 1374 (Fed. Cir. 2017). Based on the foregoing, an effective date earlier than October 14, 2015, the date of the DBQ, is not warranted for loss of smell secondary to Parkinson’s disease. Conclusion of all claims for earlier effective dates For the reasons and bases noted above, an effective date earlier than February 15, 2011 is not warranted for the grant of service connection for Parkinson’s disease, motor impairment (right upper extremity, left upper extremity, right lower extremity, left lower extremity), constipation, speech changes, motor impairment with loss of automatic movements (right facial, left facial), headaches, or SMC. An effective date earlier than October 14, 2015 is not warranted for the grant of service connection for loss of smell. Resolving reasonable doubt in the Veteran’s favor, an effective date of February 15, 2011, and no earlier, is warranted for the grant of service connection for difficulty chewing and swallowing as secondary to Parkinson’s disease. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Increased Rating Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. Id. § 4.3. Further, a disability rating may require re-evaluation in accordance with changes in a Veteran’s condition. It is thus essential in determining the level of current impairment that the disability is considered in the context of the entire recorded history. Id. § 4.1. Nevertheless, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). “Staged” ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number is “built up” with the first two digits being selected from that part of the schedule most closely identifying the part, and the last two digits being “99” for an unlisted condition. In a December 2018 VA Form 646, the Veteran’s attorney requested that the Veteran be scheduled for an examination to evaluate his disabilities, and broadly stated that his conditions have worsened. However, the claims file includes sufficient evidence, to include records after December 2018, with which the Board can assess the severity of some of the Veteran’s disabilities; thus, examinations are not required for the disabilities evaluated below. In addition, in February 2021 correspondence, the Veteran’s attorney requested that a decision be issued as soon as soon as possible; thus, where appropriate, the Board will adjudicate the issues. 13. Entitlement to an initial rating in excess of 10 percent for speech changes The Veteran’s disability is rated under DC 6599-6516. He would be entitled to a 30 percent rating if he had hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. The April 2011 examination report reflects that the Veteran reported difficulty in pronouncing words (articulation). The examiner stated that in regard to his speech, the Veteran is able to be understood. The October 2015 DBQ reflects that the Veteran had mild speech changes. The Veteran was noted to have developed slurred speech in December 2017, thought to be related to a migraine, and placed on medication (Topamax). VA clinical records note that he had soft speech (e.g., March 2015 and May 2015), but other records reflect that he had a normal speech rate, tone, and/or volume (e.g., January 2015, February 2015, August 2016, July 2018, July 2019. August 2019, September 2019, October 2019, and November 2019). There are no lay statements alleging that the Veteran has hoarseness; regardless, a lay person is not competent to provide evidence of thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. The evidence is against a finding that the Veteran has hoarseness, to include with thickening or nodules of the cords, polyps submucous infiltration, or pre-malignant changes on biopsy. Thus, a higher evaluation is not warranted under DC 6516. He is also not entitled to a higher evaluation under DC 6519 (aphonia) because the evidence is against a finding that he has a constant inability to speak above a whisper or to communicate. 14. Entitlement to an initial rating in excess of 10 percent for constipation The Veteran’s disability is rated as 10-percent disabling under DC 7399-7319. A higher rating of 30 percent under DC 7319 requires a disability picture akin to irritable colon syndrome resulting in symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met); cf Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned). The requirement under DC 7319 of diarrhea or alternating diarrhea and constipation "with" more or less constant abdominal distress means that both factors are required. A December 2010 VA clinical record (prior to the rating period on appeal) reflects that the Veteran reported that he “sometimes” has diarrhea and “sometimes” constipation. The report is unremarkable for abdominal distress on a more or less constant basis. The April 2011 examination report reflects that the Veteran did not report a problem with fecal incontinence, but stated that he suffers from frequent constipation. The report is unremarkable for diarrhea or more or less constant abdominal distress. The October 2015 DBQ reflects that the Veteran reported moderate constipation. It is unremarkable for diarrhea or more or less constant abdominal distress. An October 2015 VA neurology report also notes that he has constipation. VA clinical records note that he had no abdominal pain (March 2018), and no diarrhea (e.g., February 2015, August 2015, April 2016, December 2018). Records in 2019 are unremarkable for pertinent complaints. There are also no lay statements noting such symptoms. As the Veteran does not have more or less constant abdominal distress with diarrhea, or alternating diarrhea and constipation, a rating in excess of 10 percent is not warranted. 15. Entitlement to an initial compensable rating for loss of smell The Veteran’s disability is rated under DC 6275 which provides for a compensable rating for complete loss of sense of smell. As noted above, an April 2011 VA contract examination report reflects that the Veteran reported that he does not experience any smell problems. A July 2012 record notes that the Veteran had a normal sense of smell. VA clinical records in 2013, 2014, and 2019 reflect that the Veteran reported that smells trigger flashbacks of his service trauma; thus, indicating that he has a sense of smell. An October 2015 DBQ reflects that the Veteran reported partial loss of sense of smell. In 2018, when reporting an increase in various Parkinson’s-related symptoms, the Veteran did not allege an increase in loss of smell or a complete loss of smell. The evidence reflects that the Veteran still has a sense of smell, albeit not normal sense. As the most probative record reflects only partial loss of sense of smell, rather than complete, a compensable evaluation is not warranted. 16. Entitlement to an initial rating in excess of 30 percent for Parkinson’s Disease with balance impairment The Veteran's disability is rated under DC 8004-6204 for peripheral vestibular disorders. Under DC 6204, the maximum evaluation of 30 percent is warranted for symptoms of dizziness and occasional staggering. As the Veteran is already in receipt of the maximum rating for his disability, and as the rating is intended to compensate the Veteran for symptoms of dizziness and occasional staggering, the Board find that it adequately compensates the Veteran. The evidence does not support that an extra-schedular rating may be warranted. The record does not reflect that the Veteran's disability has caused marked interference with employment (meaning above and beyond what is contemplated by his assigned schedular rating) or necessitated frequent periods of hospitalization, or that it causes effects of similar severity not contemplated by the rating assigned for this disability. See Thun v. Peake, 22 Vet. App. 111 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. Conclusion of claims for increased ratings The Veteran is competent to report loss of smell, difficulty with speech, and bowel difficulties; however, the clinical records noting his complaints and/or noting the clinicians’ observations (such as with his voice) are against a finding that the severity of his disabilities warrants increased ratings. Moreover, he has not provided lay statements as to chronic complete loss of smell, or of diarrhea with more or less constant abdominal distress. In addition, he has not provided probative evidence that his symptoms are not adequately compensated by the rating code. For these reasons and bases, increased ratings are not warranted. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND 17. Entitlement to an initial rating in excess of 30 percent for right upper extremity motor impairment is remanded. 18. Entitlement to an initial rating in excess of 20 percent for left upper extremity motor impairment is remanded. 19. Entitlement to an initial rating in excess of 20 percent for right lower extremity motor impairment is remanded. 20. Entitlement to an in initial rating in excess of 20 percent for left lower extremity motor impairment is remanded. 21. Entitlement to an initial compensable rating for right facial impairment is remanded. 22. Entitlement to an initial compensable rating for left facial impairment is remanded. 23. Entitlement to an initial rating in excess of 30 percent for headaches is remanded. 24. Entitlement to an initial rating in excess of difficulty chewing and swallowing is remanded. The most recent DBQ is from October 2015, which is now more than five years old. The mere passage of time does not render an old examination inadequate. Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007). As noted above, in a December 2018 VA Form 646, the Veteran’s attorney requested that the Veteran be scheduled for an examination to evaluate his disabilities, and stated that his conditions have worsened. In addition, VA clinical records in December 2018 note a report of increased frequency and severity of headaches, and a March 2018 record reflects that the Veteran felt he had an increase in several symptoms which he felt may be due to medication, but which the nurse did not necessarily agree. The Veteran is competent to report difficulty with his conditions and perceives that it has worsened. See Snuffer v. Gober, 10 Vet. App. 400 (1997). Therefore, he should be afforded another examination. The Veteran has also stated that he would be seeing an outside provider for his health based on convenience (see October 2019 VA clinical record). Thus, VA should attempt to obtain all pertinent records. Accordingly, these remaining claims are REMANDED for the following additional development and consideration: 1. Ask the Veteran to complete a VA Form 21-4142 for any treatment for his Parkinson’s disease-related disabilities of bilateral upper and lower extremity motor impairment, bilateral facial impairment, headaches, and difficulty with chewing and swallowing. 2. Also obtain the Veteran’s updated VA treatment records from November 2019 to present. 3. Schedule the Veteran for an examination to determine the current severity of his Parkinson’s related disabilities of bilateral upper and lower extremity motor impairment, bilateral facial impairment, headaches, and difficulty with chewing and swallowing. KEITH ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Wishard 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.