Citation Nr: 21023181 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 19-20 178 DATE: April 20, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a respiratory disability, to include residuals of a collapsed left lung, is denied. Entitlement to service connection for a cardiovascular disability (claimed as high blood pressure and increased heart rate) is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to an initial compensable rating for service-connected left chest scar is denied. Entitlement to a 10 percent rating based upon multiple, noncompensable, service-connected disabilities is denied. Entitlement to an effective date earlier than December 20, 2017, for the award of service connection for unspecified depressive disorder is denied. REMANDED Entitlement to service connection for pancreatitis is remanded. Entitlement to service connection for anxiety is remanded. Entitlement to a compensable rating for service-connected migraines is denied. Entitlement to a rating in excess of 30 percent for service-connected unspecified depressive disorder is denied. Entitlement to an effective date earlier than December 20, 2017 for the award of service connection for a left chest scar is remanded. Entitlement to an effective date earlier than December 20, 2017 for the award of service connection for migraines is remanded. FINDINGS OF FACT 1. The Veteran does not meet VA’s auditory threshold criteria for a hearing loss disability for service connection purposes. 2. The evidence is against a finding that the Veteran has a respiratory disability that began during active service, or is otherwise related to an in-service event, injury, or disease, to include as residuals of a collapsed left lung. 3. The evidence is against finding that the Veteran’s cardiovascular disability began during active service, or is otherwise related to an in-service event, injury, or disease. 4. The evidence is against finding that the Veteran has a right knee disability that began during active service, or is otherwise related to an in-service event, injury, or disease. 5. The evidence is against finding that the Veteran has a left knee disability that began during active service, or is otherwise related to an in-service event, injury, or disease. 6. The Veteran’s service-connected left chest scar has not been manifested by an area or areas of 144 square inches (929 sq. cm) or greater and is not painful or unstable. 7. The Veteran is in receipt of compensable evaluations for service-connected disabilities during the entire period on appeal. 8. The Veteran filed a claim for service connection for unspecified depressive disorder on December 20, 2017; no communication received prior to December 20, 2017 can be construed as a claim for service connection for unspecified depressive disorder. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for bilateral hearing loss have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 2. The criteria for establishing service connection for a respiratory disability, to include residuals of a collapsed left lung, have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for establishing service connection for a cardiovascular disability have not been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a right knee disability have not been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a left knee disability have not been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for an initial compensable rating for a left chest scar have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7805. 7. The criteria for a 10 percent evaluation for multiple, noncompensable, service-connected disabilities under 38 C.F.R. § 3.324 are not satisfied. 38 U.S.C. § 1155; 38 C.F.R. § 3.324. 8. The criteria for an effective date earlier than December 20, 2017, for the award of service connection for unspecified depressive disorder have not been satisfied. 38 U.S.C. § 5107, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1988 to July 1998. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that additional VA treatment records have been associated with the record since the last Statement of the Case (SOC). However, a waiver of initial review by the agency of original jurisdiction (AOJ) was submitted by the Veteran’s representative in March 2020, and additional VA treatment records associated with the claims file since are either duplicative or irrelevant to the issues being decided below. Thus, initial review of the evidence by the Board with respect to the claim on appeal is appropriate. See 38 U.S.C. § 7105(e); 38 C.F.R. § 20.1305(c). Additionally, the Veteran, through his representative, raised the issue of entitlement to a total disability rating based on individual unemployability (TDIU) pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) in August 2019. This issue was withdrawn, however, in the afore-mentioned March 2020 correspondence. Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. Bilateral hearing loss. The record reflects that the Veteran is currently service connected for tinnitus, and he asserts in the present appeal that he also has bilateral hearing loss that is related to service. After review of the evidence, however, the Board finds that the Veteran does not currently have a diagnosed hearing loss disability for service-connection purposes. Impaired hearing will be considered a disability for service connection purposes, when the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993). The Veteran was afforded a VA audiological examination in June 2019. The examination of both ears did not find thresholds over 40 decibels for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz, or thresholds of 26 decibels or greater for at least three of these frequencies. Speech recognition scoring in both ears were 100 percent. Thus, the Veteran has not met the auditory threshold criteria for hearing loss under 38 C.F.R. § 3.385. There is no additional evidence in significant conflict with the results of the above examinations that found no current bilateral hearing loss disability. The first key element for any grant of service connection is a finding of a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Therefore, as the preponderance of the evidence is against a finding of hearing loss for VA purposes, service connection must be denied. 2. A respiratory disability. The Board notes as an initial matter that the Veteran filed a service connection claim for a left lung collapse. While the record reflects such an in-service event in 1994 due to a fractured rib, resulting in the left chest tube scar for which he is currently service-connected, the evidence does not reflect any current residuals of his lung collapse other than this scar. Upon VA examination in April 2018, it was noted that his lung collapse resolved after in-service treatment, and there is no evidence of any chronic disability related to it. In-service chest diagnostics in 1996 were normal, as were additional diagnostics performed in 2016. The examiner noted, however, that the Veteran’s current respiratory complaints are related to a diagnosis of chronic obstructive pulmonary disease (COPD). Other than the Veteran’s left lung collapse for which there are no current residuals, the Veteran’s service treatment records (STRs) show no complaints, diagnosis, or treatment related to a respiratory disability such as COPD. Examination of the lungs and chest during his 1998 separation examination was normal. COPD is not shown by medical evidence until its diagnosis in 2011, many years after the Veteran’s separation from service. To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s medical records that are absent a respiratory disability other than his resolved left lung collapse until his COPD diagnosis in 2011. The Board notes that the Veteran has not argued, nor does the medical evidence suggest, that his current COPD is related to his resolved left lung collapse. While it acknowledges that no examiner has provided an opinion as to a relationship between the Veteran’s COPD and his collapsed left lung in service, a VA medical examination or opinion is necessary when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). As noted above, his collapsed lung resolved in service, and the evidence does not suggest that his 2011 diagnosed COPD is related. The Veteran has also provided no evidence or even argument as to such a relationship. As such, the Board finds the evidence against the third McClendon criteria being met, and remand for an additional opinion is not warranted. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 3. A heart disability. The Veteran claims service connection for a heart condition, specifically asserting in his initial service connection claim that he was diagnosed in service with high blood pressure (hypertension) and an elevated heart rate (tachycardia). Medical treatment records during the appeal do note a history of hypertension and tachycardia/atrial fibrillation. Thus, the Board as recharacterized his claim as one for a cardiovascular disability. The Veteran’s STRs, despite his assertions to the contrary, are negative for complaints, diagnosis, or treatment related to a chronic cardiovascular disability. While one STR notes an elevated blood pressure reading of 152/104 in October 1997 during treatment for an acute episode of bronchitis, this does not constitute hypertension for VA compensation purposes. A diagnosis of hypertension requires diastolic blood pressure of predominantly 90 or greater, or systolic blood pressure of predominantly 160 or greater, and for VA purposes, must be confirmed by readings two or more times on at least three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). During the 1998 separation examination, his blood pressure was normal, and in a corresponding report of medical history, the Veteran specifically denied having had heart trouble or high/low blood pressure. If cardiovascular problems were present during service, the Board would expect the Veteran would have responded “yes” when asked if he had heart trouble or high/low blood pressure at separation because a reasonable person would have interpreted the question to include symptoms of a cardiovascular issue. Moreover, the Veteran responded affirmatively when asked whether he had other conditions at separation and the Board would thus expect the Veteran to have also responded affirmatively to having cardiovascular symptoms. A disability is not shown by medical evidence until he established VA medical care in June 2007, with treatment records at the time noting merely a history of hypertension and tachycardia. He has submitted no medical evidence showing such disabilities prior to this date. As a chronic disability is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of such is not shown, in-service incurrence of a current heart disability cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s report of medical history at separation from service where he denied symptoms indicative of a possible cardiovascular disability. The Board finds the report of medical history at separation from service to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. The record reflects no medical opinion relating any current cardiovascular disability ot the Veteran’s military service. While the Board acknowledges that the Veteran has not been afforded a VA examination for his claim, as an in-service onset of his disability is not suggested by the medical record, despite his assertions that he had high blood pressure and an elevated heart rate in service, remand for an examiner’s opinion is not warranted. See McLendon, 20 Vet. App. 79. For the above reasons, the preponderance of the evidence is against the claim and service connection must be denied. 4. Bilateral knee disabilities. The Veteran asserts that he has bilateral knee disabilities that are related to service. His STRs do note treatment for bilateral retropatellar pain syndrome. As an initial matter, however, it is unclear as to whether the Veteran has current bilateral knee disabilities for service connection purposes. Of note, a VA examination afforded in April 2018, which included diagnostic testing, did not reveal any diagnosed knee disability, nor does the examination report reflect any objective evidence of functional impairment associated with knee pain. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018) (finding pain resulting in functional impairment, even if there is no identified underlying diagnosis, can constitute a disability); Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 398 (2020) (finding that the holding in Saunders is not limited to pain alone, but rather, the definition of “disability” in 38 U.S.C. § 1110 (and by implication 38 U.S.C. § 1131) and includes any condition that results in functional impairment of earning capacity). The Board nevertheless acknowledges the Veteran’s subjective reports during the examination that he has bilateral knee pain that affects his ability to walk. However, even if the Board were to afford the Veteran the benefit of the doubt and determine that the evidence reflects current bilateral knee disabilities, it is against a finding that there is a nexus to his in-service knee pain. During his 1998 separation examination, while a history of knee pain was noted, evaluation of the lower extremities at the time was normal. A knee disability is not suggested again by medical evidence until approximately February 2002, with treatment providers noting that the Veteran’s “physical problems includes both knee,” with nothing more. An April 2002 treatment problem notes the Veteran reporting that a self-described “chronic knee problem” was “acting up.” The remaining medical records is absent treatment or complaints regarding the knees until his December 2017 service connection claim. More recent VA treatment records are negative for knee pain noted as an active problem or even as past medical history, while pain associated with other musculoskeletal issues (e.g. neck and back pain) are noted. As a chronic knee disability is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of such is not shown, in-service incurrence of any current chronic knee disability cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s medical treatment records beginning with his separation examination, which are absent knee complaints outside of one instance in 2002. The Veteran’s post-service VA treatment records are extensive, and the Board would expect that he would report ongoing knee pain more than once between his military service and his service connection claim filed nearly two decades later. Further, the only medical opinion of record was a negative opinion provided by the April 2018 VA examiner, who performed a physical examination and reviewed the pertinent medical history. The examiner explained that, while retropatellar pain was noted in service as due to running on pavement, there was no evidence of current, chronic, and continuous treatment or care to establish a nexus between his current report of knee pain and service. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinion is also supported by other evidence of record, including the lack of complaints of post-service knee pain other than the previously noted reports in early 2002. For the above reasons, the Board finds preponderance of the evidence is against the claim and service connection must be denied. As to all of the claims denied above, the Board has considered the Veteran’s statements, to include his assertions that his claimed disabilities are related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., hearing loss, pain, and shortness of breath; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinions rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The evidentiary record does not reasonably raise the prospect that the Veteran’s disability is not and cannot be adequately rated under the Rating Schedule. 5. A compensable rating for a left chest scar. The Veteran was awarded service connection for a left chest scar as a residual of a tube insertion due to his in-service left lung collapse. A noncompensable (zero percent) rating was assigned. He asserts that the severity of his scar warrants a higher initial rating. The Veteran’s left chest scar is rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7805 was not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate Diagnostic Code. A VA respiratory examination for the purposes of the Veteran’s respiratory disability claim notes a superficial, linear scar of the anterior trunk measuring 4.6 by 0.1 centimeters. There is no other medical evidence in significant conflict with the above findings, and the Veteran has provided no additional evidence or argument as to the severity of his left chest scar. As such, the Board finds the evidence against the assignment of a compensable rating for the Veteran’s scar under Diagnostic Code 7805 as there is no evidence of disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04. Further, the Veteran’s scar is not of the head, face, or neck, is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does not cover an area or areas of 144 square inches or greater. Moreover, the Veteran’s scar is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Thus, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for his left chest scar. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Board is sympathetic to the Veteran’s lay statements that his scar is worse than currently evaluated and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disability is evaluated. The medical and lay evidence has been assessed by the Board in determining the overall disability rating. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. 6. A compensable rating based on multiple, noncompensable, service-connected disabilities. The Veteran appeals the denial of a compensable rating based on multiple, noncompensable, service-connected disabilities. Whenever a veteran is suffering from two or more separate permanent service-connected disabilities of such character as clearly to interfere with normal employability, even though none of the disabilities may be of compensable degree under the 1945 Schedule for Rating Disabilities, the rating agency is authorized to apply a 10-percent rating, but not in combination with any other rating. 38 C.F.R. § 3.324. However, the provisions of 38 C.F.R. § 3.324 are predicated on the existence of only noncompensable service-connected disabilities. Once a compensable rating for any service-connected disability has been awarded, the applicability of the provisions under 38 C.F.R. § 3.324 is rendered moot. See Butts v. Brown, 5 Vet. App. 532, 541 (1993). In this case, the Veteran has been assigned a 30 percent evaluation for his service-connected unspecified depressive disorder and 10 percent for tinnitus during the entire period on appeal. Consequently, the issue of entitlement to a compensable rating based on multiple noncompensable service-connected disabilities pursuant to 38 C.F.R. § 3.324 has been rendered moot. Accordingly, the appeal is denied. Effective Dates 7. An effective date earlier than December 20, 2017 for unspecified depressive disorder. The Veteran was granted service connection for unspecified depressive disorder in the rating decision on appeal and was assigned a December 20, 2017 effective date. He asserts that an earlier effective date should have been awarded. Except as otherwise provided, the effective date of an award of compensation based on an original claim will be the day following separation from active service or the date entitlement arose, if the claim is received within one year after separation from service; otherwise, the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. For this particular claim, the VA administrative claims process recognizes formal and informal claims. A formal claim is one that has been filed in the form prescribed by VA. See 38 C.F.R. § 3.151 (2013). An informal claim may be any communication or action, indicating an intent to apply for one or more benefits under VA law. 38 C.F.R. §§ 3.1(p), 3.155(a) (2013). An informal claim must be written, see Rodriguez v. West, 189 F. 3d. 1351 (Fed. Cir. 1999), and it must identify the benefit being sought. Brannon v. West, 12 Vet. App. 32, 34-5 (1998). 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. The amendments implement the concept of an intent to file a claim for benefits, which operates similarly to the informal claim process, but requires that the submission establishing a claimant’s effective date of benefits must be received in one of three specified formats. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen under 38 C.F.R. § 3.157. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (now codified at 38 C.F.R. §§ 3.1(p), 3.151, 3.155). The amendments apply only to claims filed on or after March 24, 2015. Prior to that date, informal claims as originally codified in 38 C.F.R. §§ 3.155 and 3.157 were allowed. Here, the record reflects that the Veteran did not file a service connection claim for any disability, let alone his service-connected depressive disorder until December 20, 2017. The evidence of record does not reflect any communication from the Veteran prior to this date that may be interpreted as a formal or informal claim for service connection for this disability. In fact, the claims file is negative for any document at all prior to a December 20, 2017 VA Form 21-0966 (Intent to File a Claim for Compensation and/or Pension). The Board acknowledges that the Veteran may have had a history of a psychiatric disorder dating prior to December 20, 2017. In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b) (2014). The date of a VA medical record will be accepted as the date of receipt of a claim when such record relates to examination or treatment of a disability for which service-connection has previously been established. Id. Simply put, this section only applies to claims for an increased rating, not an initial claim for service connection. Accordingly, the Board concludes that the date of the September 10, 2018, VA Form 21-0966 is the proper effective date for the grant of service connection for an unspecified depressive disorder, and the appeal is denied. REASONS FOR REMAND While the Board regrets further delay, the Veteran’s remaining claims must be remanded for additional development. 1. Effective dates for migraines and a left chest scar. The January 2019 rating decision on appeal granted the Veteran service connection for migraines and a left chest scar. While the Veteran’s timely notice of disagreement included both the issues of the initial rating assigned and its December 20, 2017 effective date, only the assigned rating was adjudicated in a subsequent SOC. Therefore, a remand for the issuance of an SOC is necessary as to entitlement to an effective date earlier than December 20, 2017 for the awards of service connection for migraines and left chest scar. See 38 C.F.R. § 19.9(c); Manlincon v. West, 12 Vet. App. 238 (1999). 2. Service connection for pancreatitis. The Veteran has a current disability of the pancreas, with medical treatment records during the appeal noting recurrent pancreatitis beginning in 2012. He was first seen by VA treatment providers in May of that year for symptoms of a cystic mass at the head of the pancreas. The mass was excised and not found to be malignant. VA treatment records since note ongoing episodes of pancreatitis of an unclear etiology. While the Veteran’s STRs show no complaints, diagnosis, or treatment related to a pancreas disability, he asserted in a statement submitted with his service connection claim that he believes his pancreatitis is related to self-medicating with excess alcohol to treat his “pain and anxiety, depression and everything else.” Essentially, he claims that his pancreatitis is secondary to alcohol abuse associated with his service-connected unspecified depressive disorder. 38 C.F.R. § 3.310. The Board notes that statutes and VA regulations provide that no compensation shall be paid if a disability is the result of a veteran’s own willful misconduct, including the abuse of alcohol and drugs. See 38 U.S.C. §§ 105, 1110; 38 C.F.R. §§ 3.1(n), 3.301; see also VAOPGPREC 2-97 (January 16, 1997). The law also precludes compensation for primary alcohol abuse disabilities, and secondary disabilities that result from primary alcohol abuse. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Thus, in order for service connection to be granted here for the Veteran’s pancreatitis, alcohol dependence must first be established as secondary to, or a component of, a service-connected disability. Here, the Veteran’s records do note a history of enrollment in a VA alcohol treatment program for alcohol dependence, and a VA mental disorders examination for the purposes of his service-connected unspecified depressive disorder confirms a history of alcohol dependence. No medical opinion is of record, however, that address the etiology of the Veteran’s pancreatitis, including whether it is secondary to a service-connected acquired psychiatric disorder. Thus, remand is necessary. 3. Service connection for anxiety. 4. An increased rating for service-connected unspecified depressive disorder. The Veteran also contends service connection is warranted for anxiety, separate from his already service-connected unspecified depressive disorder. As an initial matter, the Board notes that pyramiding, the evaluation of the same disability (or the same manifestation of a disability) under different diagnostic codes, is to be avoided when rating an appellant’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for an appellant to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Therefore, it would be pyramiding to consider symptoms such as anxiety for both the service-connected depressive disorder and a separate acquired psychiatric disorder. While the Veteran can be separately service connected for different acquired psychiatric disorders, the overlapping psychiatric symptoms for each separate disorder cannot be rated more than once. In the Veteran’s case, the evidence does not currently show a current clinical diagnosis of an anxiety condition. Upon VA examination in April 2018, while the Veteran reported excessive worry, the examiner did not find that this met the diagnostic criteria for an anxiety disorder, nor was anxiety noted to be a symptom of his service-connected depressive disorder. However, the Veteran is also seeking an increase in the 30 percent disability rating he is currently assigned for his service-connected unspecified depressive disorder. While the aforementioned VA examination in April 2018 assessed the nature and severity of his now service-connected disability, more recent statements provided by the Veteran and his representative suggest that the severity of his disability may warrant a higher rating due to additional symptoms, to include anxiety. As such, remand for an updated VA examination is necessary. As the results of a new VA mental disorders examination would also touch on the Veteran’s claim for a separate award of service connection for anxiety, that intertwined issue must be deferred. 5. An increased rating for service-connected migraines. The Veteran is in receipt of an initial noncompensable (zero percent) rating for migraines. While a VA examination was afforded in April 2018 to determine the nature and severity of this disability (as well as its etiology, as it was also for the purposes of his initial service connection claim), the Veteran has asserted more recently that its current severity warrants a higher rating due to subjective complaints of prostrating attacks of headache pain. As such, remand for an updated VA examination is also necessary for this claim. The matters are therefore REMANDED for the following action: 1. Unless the benefits sought are granted in full, issue an SOC as to the claims for entitlement to an effective date earlier than to December 20, 2017 for the awards of service connection for migraines and a left chest scar. This issuance should include notification of the need to timely file a substantive appeal on these issues. 2. Ask the Veteran to identify all outstanding treatment records relevant to his remaining claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of their unavailability. 3. After records development is completed, schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that any current pancreatitis onset during service or is otherwise related to an in-service injury, event, or disease. The examiner should also address whether any current pancreatitis is at least as likely as not (a) caused, or (b) aggravated (i.e., worsened beyond natural progression) by his service-connected unspecified depressive disorder, to include as a result of alcohol abuse. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. 4. After records development is completed, schedule the Veteran for a VA examination to determine the current symptoms, level of severity, and functional impairment associated with his service-connected psychiatric disorder. The examiner should review the claims file. 5. After records development is completed, schedule the Veteran for a VA examination to determine the current symptoms, level of severity, and functional impairment associated with his service-connected migraines. The examiner should review the claims file. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.