Citation Nr: 21031073 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 18-10 876 DATE: May 20, 2021 ORDER A disability rating in excess of 40 percent for degenerative disc disease of the lumbar spine (lumbar spine disability) is denied. A disability rating in excess of 20 percent for radiculopathy of the left lower extremity is denied. A disability rating in excess of 10 percent for radiculopathy of the right lower extremity is denied. The application to reopen the previously denied claim for service connection for a gastrointestinal disability is denied. Service connection for obstructive sleep apnea is granted. Service connection for exotropia is granted. Service connection for unspecified trauma and stressor-related disorder (psychotic disorder) is granted. Service connection for erectile dysfunction is denied. Service connection for radiculopathy of the right upper extremity is denied. Service connection for radiculopathy of the left upper extremity is denied. Service connection for a right knee disability is denied. Service connection for a left knee disability is denied. Service connection for a right ankle disability is denied. Service connection for a left ankle disability is denied. Service connection for a right foot disability is denied. Service connection for a left foot disability is denied. An effective date prior to November 15, 2011 for the award of service connection for lumbar spine degenerative disc disease is denied. An effective date prior to November 15, 2011 for the award of service connection for radiculopathy of the left lower extremity is denied. REMANDED Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicide agents during service, is remanded. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents during service, is remanded. Entitlement to service connection for renal cell carcinoma, to include as due to exposure to herbicide agents during service, is remanded. Entitlement to service connection for a skin disability, to include as due to exposure to herbicide agents during service, is remanded Entitlement to service connection for peripheral neuropathy is remanded. Entitlement to service connection for residuals of a jaw fracture is remanded. Entitlement to an effective date prior to February 5, 2018 for the award of service connection for radiculopathy of the right lower extremity is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran's service-connected lumbar spine disability has not been productive of incapacitating episodes or ankylosis. 2. The Veteran's radiculopathy of the left lower extremity has been manifested by no more than moderate incomplete paralysis, with symptoms of intermittent and constant pain, numbness, and paresthesia. 3. The Veteran's radiculopathy of right lower extremity has been manifested by no more than mild incomplete paralysis, with symptoms of intermittent and constant pain, numbness, and paresthesia 4. By a decision entered in February 2004, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for a gastrointestinal disability because there was no evidence the Veteran manifested a gastrointestinal disability; the Veteran was advised of the RO's decision and of his appellate rights. 5. The Veteran did not initiate an appeal of the RO's February 2004 decision during the one-year period following the mailing of notice of that decision; nor was any new evidence received within a year. 6. The evidence received since the February 2004 rating decision does not address an unestablished element of the claim and does not raise a reasonable possibility of substantiating the claim with regard to the claim for a gastrointestinal disability. 7. It is at least as likely as not that the Veteran's obstructive sleep apnea is secondary to his service-connected degenerative disc disease of the lumbar spine and bilateral lower extremity radiculopathy. 8. The Veteran's exotropia, which pre-existed service, increased in severity beyond natural progression during service. 9. It is at least as likely as not that the Veteran's psychiatric disorder began in service. 10. None of the competent and credible evidence reflects that the Veteran has erectile dysfunction that may be associated with service or a service-connected disability. 11. The preponderance of the evidence is against finding that the Veteran's radiculopathy of the right upper extremity began during active service or is otherwise related to an in-service injury or disease. 12. The preponderance of the evidence is against finding that the Veteran's radiculopathy of the left upper extremity began during active service or is otherwise related to an in-service injury or disease. 13. None of the competent and credible evidence reflects that the Veteran has a right knee disability that may be associated with service or a service-connected disability. 14. None of the competent and credible evidence reflects that the Veteran has a left knee disability that may be associated with service or a service-connected disability. 15. None of the competent and credible evidence reflects that the Veteran has a right ankle disability that may be associated with service or a service-connected disability. 16. None of the competent and credible evidence reflects that the Veteran has a left ankle disability that may be associated with service or a service-connected disability. 17. The preponderance of the evidence is against finding that the Veteran's right foot disability began during active service or is otherwise related to an in-service injury or disease. 18. The preponderance of the evidence is against finding that the Veteran's left foot disability began during active service or is otherwise related to an in-service injury or disease. 19. By a decision entered in February 2004, a VA RO denied service connection for lumbar spine degenerative disc disease; the Veteran was advised of the RO's decision and of his appellate rights. 20. The Veteran did not initiate an appeal of the RO's February 2004 decision during the one-year period following the mailing of notice of that decision; nor was any new evidence received within a year. 21. The Veteran's application to reopen the claim for service connection for a lumbar spine disability was received on November 15, 2011. 22. The effective date of service connection for left lower extremity radiculopathy secondary to service-connected lumbar spine disability is November 15, 2011, the date from which he is service-connected for his lumbar spine disability. CONCLUSIONS OF LAW 1. The criteria for an award of a disability rating in excess of 40 percent for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242, 5243. 2. The criteria for an award of a disability rating in excess of 20 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.123, 4.124a, Diagnostic Code 8520. 3. The criteria for an award of a disability rating in excess of 10 percent for radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.123, 4.124a, Diagnostic Code 8520. 4. The February 2004 rating decision that denied service connection for a gastrointestinal disability is final. 38 U.S.C. § 7105 (2002); 38 C.F.R. §§ 20.200, 20.201, 20.302, 20.1103 (2003). 5. New and material evidence has not been received to reopen the Veteran's claim for service connection for a gastrointestinal disability. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2020). 6. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for obstructive sleep apnea as secondary to service-connected degenerative disc disease of the lumbar spine and bilateral lower extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 7. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for exotropia have been met. 38 U.S.C. §§ 1110, 1111, 1153, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306. 8. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for unspecified trauma- and stressor-related disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for an award of service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 10. The criteria for an award of service connection for radiculopathy of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 11. The criteria for an award of service connection for radiculopathy of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 12. The criteria for an award of service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 13. The criteria for an award of service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 14. The criteria for an award of service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 15. The criteria for an award of service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 16. The criteria for an award of service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 17. The criteria for an award of service connection for a left foot disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 18. The criteria for entitlement to an effective date prior to November 15, 2011 for the award of service connection for lumbar spine degenerative disc disease have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 19. The criteria for entitlement to an effective date prior to November 15, 2011 for the award of service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. § 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 August 1967 to May 1969, to include service in Korea. His decorations include the National Defense Service Medal, the Good Conduct Medal, and the Armed Forces Expeditionary Medal (Korea). These matters come to the Board of Veterans' Appeals (Board) on appeal from March 2015, December 2017, and April 2018 rating decisions by a VA RO. In a June 2019 decision, the Board granted a disability rating of 40 percent for the Veteran's lumbar spine disability, as well as the Veteran's application to reopen his previously denied claim for service connection for exotropia. The June 2019 Board decision denied a disability rating in excess of 20 percent for radiculopathy of the left lower extremity and the Veteran's application to reopen his previously denied claim for service connection for a gastrointestinal disability. The June 2019 Board decision also denied the appeals for service connection for obstructive sleep apnea and earlier effective dates for service connection for the lumbar spine disability and radiculopathy of the left lower extremity. The June 2019 Board decision remanded the claims for service connection for exotropia, diabetes mellitus, hypertension, renal cell carcinoma, peripheral neuropathy, and residuals of a jaw fracture. In a March 2021 decision, the Board vacated the June 2019 decision to the extent that it denied a disability rating in excess of 40 percent for the lumbar spine disability, a disability rating in excess of 20 percent for radiculopathy of the left lower extremity, the Veteran's application to reopen his previously denied claim for service connection for a gastrointestinal disability, service connection for sleep apnea, and earlier effective dates for service connection for the lumbar spine disability and radiculopathy of the left lower extremity, and to the extent it remanded the remaining claims. In a March 30, 2021 correspondence, the Veteran's attorney requested that the Board wait 90 days before issuing a decision in this appeal. In April 2021, the attorney submitted additional evidence and waived any remaining time to send additional evidence or arguments. Accordingly, the Board will proceed with adjudicating the appeal. Although not developed as a distinct issue, the issue of entitlement to a TDIU on appeal was raised as a component of the rating claims for the lumbar spine disability and bilateral lower extremity radiculopathy in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009) (where there is evidence of unemployability raised by the record during a rating appeal period, the TDIU is an element of an initial rating or increased rating). HIGHER RATINGS Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. If there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). With any form of arthritis, painful motion is an important factor of disability; the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. The intent of the schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. 1. A disability rating in excess of 40 percent for degenerative disc disease of the lumbar spine is denied. The Veteran seeks a disability rating in excess of 40 percent for his service-connected lumbar spine disability. Throughout the appellate period, the Veteran's lumbar spine disability has been evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5243-5242. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. All spinal disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine. Further, if a Veteran has x-ray evidence to establish degenerative arthritis of the spine with noncompensable limitation of motion, he or she is entitled to a 10 percent disability rating for each major joint or group of minor joints affected by limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. If the Veteran has Intervertebral Disc Syndrome (IVDS), the Veteran may also be evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Ultimately, the Veteran's disability rating will depend on which diagnostic code results in the higher evaluation. The General Rating Formula provides the following ratings for disability of the thoracolumbar spine, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease: A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine; a 50 percent evaluation requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a. The Board notes that there was a recent regulatory update to the VA rating criteria for evaluating musculoskeletal disorders, effective February 7, 2021. See 85 Fed. Reg. 230 (Nov 30, 2020). Although the portion of the rating schedule that addresses the musculoskeletal system was revised from February 7, 2021 onwards, Diagnostic Code 5242 was not changed. In December 2014, the Veteran underwent a VA examination. On examination, the Veteran reported pain on movement and weight bearing, the examiner noted objective evidence of pain on motion and functional loss due to lack of endurance and pain. There were no incapacitating episodes of spine disease. After repetitive testing, the thoracolumbar spine range of motion for flexion was 0 to 35 degrees. The examiner also noted flexion was limited by an additional 5 degrees due to repeated use over time. The VA examiner noted the functional impact of pain and lack of endurance on the lumbar spine disability was an inability to stand or ambulate for extended periods. The examiner also noted the Veteran used a cane and had disc protrusion at L4-L5 with pressure on the left greater than the right. The Veteran was afforded another VA examination in March 2018. The examiner noted the presence of degenerative arthritis and intervertebral disc syndrome. he thoracolumbar spine range of motion for flexion was 0 to 40 degrees. Extension was 0 to 15 degrees and left and right lateral flexion were to 15 degrees and left and right lateral rotation were 20 degrees. The Veteran was noted to use a cane for ambulation. There was objective evidence of pain on weightbearing and passive range of motion, but the Veteran had no additional functional loss due to pain or functional loss after repetitive testing. The examiner noted no evidence of ankylosis or incapacitating episodes. VA medical records received during the appellate period do not show lumbar spine ankylosis, or incapacitating episodes. In light of the foregoing, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 40 percent for the Veteran's lumbar spine disability throughout the appellate period. The evidence shows that he had functional loss due to pain, including flexion that was limited to as much as 35degrees with repetitive use, with an additional 5 degrees of functional loss with repeated use over time. The Board finds no evidence that would support the assignment of higher evaluation, as the Veteran does not have incapacitating episodes and does not suffer from ankylosis, symptomatology necessary for a higher rating. Although the Board finds the Veteran's assertions as to the severity of his symptoms to be credible, these reports alone do not warrant the assignment of a disability rating in excess of 40 percent. The Board has considered range of motion findings in passive and non-weight bearing situations, consistent with Correia v. McDonald, 28 Vet. App. 158 (2016). Here, the Veteran has been shown to be able to perform repetitive range of motion testing. Repetitive range of motion and passive range of motion resulted in limitation of motion to 35 degrees in December 2014 and 40 degrees in March 2018, with additional loss of function due to pain, which more closely approximates a disability rating of 40 percent. Consideration has also been given to an increased evaluation for the Veteran's lumbar spine disability under the formula for rating IVDS. However, the medical evidence does not indicate, and the Veteran does not contend, that he has been prescribed bed rest by a physician based on incapacitating episodes. The Veteran's service-connected lumbar spine disability does not warrant a higher disability rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes at any time during the appellate period. Thus, the Board concludes that an evaluation in excess of 40 percent is denied, as his disability picture is not more closely approximated by a 50 percent rating under the General Rating Formula for Diseases and Injuries of the Spine or a 60 percent rating under the Formula for Rating Intervertebral Disc Syndrome. 38 C.F.R. § 4.71a. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against a higher rating, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The appeal of this issue is denied. 2. A disability rating in excess of 20 percent for radiculopathy of the left lower extremity is denied. 3. A disability rating in excess of 10 percent for radiculopathy of the right lower extremity is denied. The Veteran seeks a disability rating in excess of 20 percent for service-connected radiculopathy of the left lower extremity, and in excess of 10 percent for service-connected radiculopathy of the right lower extremity. The Veteran's radiculopathy of the lower extremities is evaluated under Diagnostic Code 8520, relating to paralysis of the sciatic nerve. Under Diagnostic Code 8520, mild incomplete paralysis warrants a 10 percent rating; moderate incomplete paralysis warrants a 20 percent rating; moderately severe incomplete paralysis warrants a 40 percent rating; and severe incomplete paralysis of the sciatic nerve with marked muscular atrophy warrants a 60 percent rating. With complete paralysis of the sciatic nerve, which warrants an 80 percent rating, the foot dangles and drops, there is no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. A note preceding the Schedule of Ratings for Diseases of the Peripheral Nerves provides that the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve. The note further states that when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in 38 C.F.R. § 4.123 will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. Id. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate, incomplete paralysis. 38 C.F.R. § 4.124. The Board notes that words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Rather, all evidence must be evaluated in arriving at a decision regarding the assignment of a disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. After a review of the record, the Board finds that an evaluation in excess of 20 percent is not warranted for radiculopathy of the left lower extremity. The Board's determination is based in part on the fact that the Veteran's reports of symptoms have been largely complaints of constant pain, intermittent pain, parasthesia, and numbness. A December 2014 VA examination report showed moderate intermittent pain, moderate numbness, and moderate parasthesia of the left lower extremity. The examiner assessed moderate incomplete paralysis. A March 2018 VA examination report noted mild constant pain, mild intermittent pain, mild parasthesia, and mild numbness. The examiner assessed mild incomplete paralysis. VA medical records during the appeal period do not otherwise show left lower extremity radiculopathy manifested by severe or moderately severe findings of parasthesia, intermittent pain, or numbness, or moderately severe or severe incomplete paralysis. The evidence more nearly approximates moderate incomplete paralysis. The conclusion that the symptoms are moderate is supported by both VA examinations and medical records. After a review of the record, the Board finds that an evaluation in excess of 10 percent is not warranted for right lower extremity radiculopathy. The Board's determination is based in part on the fact that the Veteran's reports of symptoms have been largely complaints of constant pain, intermittent pain, parasthesia, and numbness. A March 2018 VA examination report noted mild constant pain, mild intermittent pain, mild parasthesia, and mild numbness. The examiner assessed mild incomplete paralysis. VA medical records during the appeal period do not otherwise show right lower extremity radiculopathy manifested by moderate, moderately severe, or severe findings of parasthesia, intermittent pain, or numbness, or moderate, moderately severe, or severe incomplete paralysis. The evidence more nearly approximates mild incomplete paralysis. The conclusion that the symptoms are mild is supported by both VA examinations and medical records. Based on the foregoing, the Board concludes that a disability rating in excess of 20 percent for the service-connected radiculopathy of the left lower extremity, and in excess of 10 percent for service-connected radiculopathy of the right lower extremity is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the assignment of higher ratings, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The appeal of these issues is denied. New and Material Evidence In general, rating decisions and Board decisions that are not timely appealed are final. See 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.1103. If new and material evidence is presented or secured with respect to a claim that has been finally disallowed, the claim shall be reopened and reviewed. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Under 38 C.F.R. § 3.156, a claimant may reopen a finally adjudicated claim by submitting new and material evidence. "New" evidence is defined as evidence not previously submitted to agency decision makers. "Material" evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). If it is determined that new and material evidence has been submitted, the claim must be reopened. The evidence is presumed credible for the purposes of reopening a claim, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Justus v. Principi, 3 Vet. App. 510 (1992). The application to reopen the claim for service connection for a gastrointestinal disability is denied. The Veteran's claim for service connection for a gastrointestinal disability was previously denied in a February 2004 rating decision. The Veteran did not file a notice of disagreement, nor was any new evidence received within a year. As such, that decision became final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 20.200, 20.201, 20.302, 20.1003 (2012). The evidence before VA at the time of the February 2004 decision consisted of the Veteran's service treatment records, post-service private treatment records, and lay statements from the Veteran and his friend. The Veteran asserted he had a gastrointestinal disability due to an inability to chew his food. See February 2004 statement. The RO denied the claim due to a lack of current disability and a lack of a nexus between the current disability and service. Since that final decision, VA has received December 2014 and March 2018 VA examinations indicating the Veteran did not have a gastrointestinal disability during the appellate period. The Board considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding U.S. Court of Appeals for Veterans Claims erred as matter of law in finding a veteran's symptoms such as pain alone, absent specific diagnosis or otherwise identified disease or injury, could not constitute a disability under 38 U.S.C. § 1110 and other relevant authorities). In Saunders, the Federal Circuit stressed that "[t]he policy underlying veterans compensation [is] to compensate veterans whose ability to earn a living is impaired as a result of their military service."; cf. Read v. Shinseki,651 F.3d 1296, 1301 (Fed. Cir. 2011) ("disability" in VA regulations is "generally associated with the veteran's inability to perform certain acts"). In this case, these principles do not support a finding that the Veteran has a current gastrointestinal disability. Notably, he has not specified how he believes his subjectively reported gastrointestinal symptoms have resulted in specific functional impairments in his earning capacity. Also, there is no competent medical or vocational evidence suggesting that his current, subjective gastrointestinal symptoms have functionally impaired his earning capacity in any way. See March 2018 VA Examination. The presence of a disability at any time during the claim process can justify a grant of service connection, even when the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, Congress specifically has limited entitlement to service connection for disease or injury to cases where such incidents have resulted in a current disability. Thus, where the evidence does not support a finding of a current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). After a full review of the record, the Board finds that the application to reopen must be denied. The Veteran has not been diagnosed with any gastrointestinal pathology. Nor is there any competent evidence showing that his current reported gastrointestinal symptoms have resulted in functional impairment in his earning capacity. The December 2014 and March 2018 VA examinations show no functional impact from his claimed gastrointestinal disability. Therefore, although these examinations are relevant to the presence of a current disability, the December 2014 and March 2018 VA examinations do not relate to an unestablished fact necessary to substantiate the claim as they show no gastrointestinal disability for VA purposes. Further, the Veteran is not competent to attribute indigestion to his inability to chew as this is not a readily ascertainable relationship given the complexity of the gastrointestinal system. Further, his lay assertions were considered by the RO in February 2004. Layno, 6 Vet. App. at 469; see also 38 C.F.R. § 3.159(a)(2). The United States Court of Appeals for Veterans Claims has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold and has characterized the phrase "raises a reasonable possibility of substantiating the claim" as "enabling rather than precluding reopening." Shade v. Shinseki, 24 Vet. App. 11 (2010). As noted, in determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The lay statements submitted during the course of the appeal do not offer any additional material information not previously considered by the RO. VA medical records received since February 2004 do not show gastrointestinal diagnosis or disability. All of the newly received evidence is duplicative, cumulative, and does not relate to an unestablished fact necessary to substantiate the claim. As such, it cannot be considered new and material. Although the threshold for reopening a claim is low, the evidence presented in this case is insufficient to reopen the claim. The application to reopen the claim for service connection for a gastrointestinal disability is denied. SERVICE CONNECTION Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). If a Veteran serves 90 days or more of active, continuous service after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent or more during the one-year period following his separation from that service, service connection for the condition may be established on a presumptive basis, notwithstanding that there is no in-service record of the disorder. See 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease, or (b) if the fact of chronicity in service in not adequately supported, by evidence of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). 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) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). A layperson is generally incapable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran's present condition (e.g., whether the Veteran's present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a). See Davidson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for obstructive sleep apnea is granted. The Veteran seeks to establish service connection for obstructive sleep apnea. He asserts that his sleep apnea is due to exposure to herbicide agents in service. Alternatively, he contends that his sleep apnea was caused by his service-connected degenerative disc disease of the lumbar spine and bilateral lower extremity radiculopathy. A May 2020 sleep apnea disability benefits questionnaire (DBQ), which was completed by private physician Dr. M.B. shows a diagnosis of obstructive sleep apnea. Thus, the question becomes whether the current disability is related to service or secondary to a service-connected disability. The evidence in favor of the Veteran's claim includes a May 2020 opinion by Dr. M.B. that it is at least as likely as not that his service-connected degenerative disc disease of the lumbar spine and bilateral lower extremity radiculopathy, as well as prescribed medicine for pain, has resulted in his diagnosed obstructive sleep apnea. Dr. M.B. reasoned that the Veteran has difficulty falling asleep at night in spite of his fatigue and sleepiness because he has trouble finding a position of comfort due to the lumbar spine disability and bilateral lower extremity radiculopathy. Dr. M.B. explained that frequent awakenings lead to fragmented sleep, which leads to a higher upper airway collapsibility which can contribute to the pathogenesis of obstructive sleep apnea. Dr. M.B. also noted that the Veteran is prescribed Percocet for his service-connected disabilities, which is well known to cause sedation, and explained that loss of airway control and respiratory depression are the most common serious adverse effects associated with sedative drugs. The Board finds the May 2020 opinion by Dr. M.B. highly probative because the examiner reviewed the claims file, discussed the relevant evidence, and provided a thorough supporting rationale for the conclusions reached. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There is no contrary medical opinion of record. Based on the foregoing, and after resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's obstructive sleep apnea is secondary to his service-connected lumbar spine disability and bilateral lower extremity radiculopathy. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for obstructive sleep apnea is granted. 2. Service connection for exotropia is granted. The Veteran seeks to establish service connection for exotropia. He asserts, in essence, that his exotropia, which pre-existed his service was aggravated during such service. The record reflects that the Veteran has been diagnosed with exotropia. See, e.g., December 2014 VA examination report. The evidence weighing in favor of the claim includes an October 2020 VA examiner's opinion that the Veteran's exotropia, which clearly and unmistakably pre-existed service, increased in severity beyond natural progress of the disease during such service. The examiner reasoned that on January 15, 1969, the Veteran had a diagnosis of 2-3 prism diopter alternative exotropia, 6 months after eye surgery in June 1968. The examiner explained that on October 15, 2020, the Veteran showed a diagnosis of 8-10 constant alternating exotropia, that he can only focus on one eye at a time, and that corrected glasses with prism does not correct his eye turn. The examiner explained that the Veteran's exotropia is not considered a refractive error of the eyes. The evidence weighing against the claim includes a December 2014 VA examiner's opinion that the Veteran exotropia, which clearly and unmistakably pre-existed service, was not aggravated beyond its natural progression by his military service. The examiner reasoned that the Veteran's had a 20-prism diopter intermittent alternating exotropia, which is comparable to that of his March 1968 service examination. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current exotropia, which clearly and unmistakably pre-existed service, was aggravated during such service. In this regard, the Board finds that the above-referenced October 2020 positive VA opinion and the December 2014 VA negative opinion are of equal weight. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for exotropia is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for exotropia is granted. 3. Service connection for unspecified trauma and stressor-related disorder is granted. The Veteran seeks to establish service connection for a psychiatric disorder. A May 2020 mental disorder DBQ, which was completed by K.G., Ph.D., shows a diagnosis of unspecified trauma and stressor-related disorder. Thus, the question becomes whether the current disability is related to service or secondary to a service-connected disability. The evidence in favor of the Veteran's claim includes a May 2020 opinion by K.G., Ph.D., that his psychiatric disorder began in service. K.G. provided a thorough review of the Veteran's military history and noted that his November 1966 pre-induction examination noted no mental health problem while his April 1969 service separation examination noted nervous trouble. K.G. also noted a lay statement by the Veteran's friend, J.N., who described how his mental health differed after his service. K.G. also opined that it is more likely than not that the Veteran's psychiatric disorder was aggravated by his service-connected lumbar spine disability and bilateral lower extremity radiculopathy. The Board finds the May 2020 opinion by K.G., Ph.D. highly probative because the examiner reviewed the claims file, discussed the relevant evidence, and provided a thorough supporting rationale for the conclusions reached. Nieves-Rodriguez, 22 Vet. App. 295. There is no contrary medical opinion of record. Based on the foregoing, and after resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's psychiatric disorder began in service. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for unspecified trauma and stressor-related disorder is granted. 4. Service connection for erectile dysfunction is denied. The Veteran seeks to establish service connection for erectile dysfunction. The Veteran's service treatment records contain no entries reflecting a diagnosis of, or treatment for, erectile dysfunction, to include in his April 1969 service separation examination and the concurrent report of medical history. The Veteran has not provided specific contentions with respect to how erectile dysfunction was incurred in or is otherwise the result of his active service. Moreover, none of the competent and credible evidence reflects that erectile dysfunction may be associated with service or a service-connected disability. No other basis for establishing service connection for erectile dysfunction is demonstrated by the evidence of record, to include on the basis of the presumptive provisions of 38 C.F.R. §§ 3.307 and 3.309 or as secondary to a service-connected disability pursuant to 38 C.F.R. § 3.310. The Board acknowledges that no VA examination has been provided in connection with the Veteran's claim. However, in the absence of any competent and credible evidence indicating that any current erectile dysfunction may be associated with service, no examination is required. In light of the foregoing, the Board must find that the preponderance of the evidence is against his claim. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Service connection for erectile dysfunction is denied. 5. Service connection for radiculopathy of the right upper extremity. 6. Service connection for radiculopathy of the left upper extremity. The Veteran seeks to establish service connection for radiculopathy of the upper extremities. The Veteran's service treatment records contain no entries reflecting a diagnosis of, or treatment for radiculopathy of either upper extremity, to include in his April 1969 service separation examination and the concurrent report of medical history. A March 2018 VA examiner noted that the Veteran had radiculopathy of both upper extremities and opined that the condition was less likely than not incurred in or caused by claimed in-service injury, event, or illness. The examiner noted the April 1969 report of medical history at service separation shows that the Veteran denied having neuritis and there were no reports of a neck condition. The examiner further explained that there was no other indication that the current bilateral upper extremity radiculopathy was by the Veteran's military service. The March 2018 examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 304. There is no contrary medical opinion of record. The Veteran believes that radiculopathy of the upper extremities is related to service. While the Veteran was competent to report symptoms of radiculopathy, such as pain and numbness, he was not competent to provide a nexus opinion with respect to the etiology of his disability. The issue is medically complex, as it requires knowledge of the neurological system and the development of bilateral upper extremity radiculopathy years after service. The record does not show that the appellant or the Veteran has or had the medical training or experience necessary to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Veteran's bilateral upper extremity radiculopathy, which is an organic disease of the central nervous system, is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. There is otherwise no competent and probative evidence that the Veteran's current bilateral upper extremity radiculopathy was manifested to a degree of 10 percent or more within one year of separation from service, or that it is otherwise related to service. As such, service connection on a direct and presumptive basis is not warranted. In the absence of any competent and probative evidence of record indicating that the Veteran's right and left upper extremity radiculopathy may be associated with a disease or injury in service, the Board must find that the preponderance of the evidence is against the claims. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The appeal of these issues must be denied. 7. Service connection for a right knee disability is denied. 8. Service connection for a left knee disability is denied. 9. Service connection for a right ankle disability is denied. 10. Service connection for a left ankle disability is denied. The Veteran seeks to establish service connection for right knee, left knee, right ankle, and left ankle disabilities. The Veteran's service treatment records contain no entries reflecting a diagnosis of, or treatment for the claimed right knee, left knee, right ankle, and left ankle disabilities, to include in his April 1969 service separation examination and the concurrent report of medical history. The Veteran has not provided specific contentions with respect to how the claimed right knee, left knee, right ankle, and left ankle disabilities were incurred in or are otherwise the result of his active service. Moreover, none of the competent and credible evidence reflects that a right knee, a left knee, a right ankle, or a left ankle disability may be associated with service or a service-connected disability. No other basis for establishing service connection for disabilities of the right knee, left knee, right ankle, and left ankle is demonstrated by the evidence of record, to include on the basis of the presumptive provisions of 38 C.F.R. §§ 3.307 and 3.309 or as secondary to a service-connected disability pursuant to 38 C.F.R. § 3.310. The Board acknowledges that no VA examination has been provided in connection with the Veteran's claims. However, in the absence of any competent and credible evidence indicating that any current right knee, left knee, right ankle, or left ankle disability may be associated with service, no examination is required. In light of the foregoing, the Board must find that the preponderance of the evidence is against his claims. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The appeal of these issues must be denied. 11. Service connection for a right foot disability is denied. 12. Service connection for a left foot disability is denied. The Veteran seeks to establish service connection for disabilities of the feet. The Veteran's service treatment records contain no entries reflecting a diagnosis of, or treatment for right or left foot disorders. The April 1969 report of medical history at service separation shows that the Veteran reported foot trouble (athletic feet). The April 1969 service separation examination report shows a normal clinical evaluation of the feet. A March 2018 VA examiner noted a diagnosis of metatarsalgia of both feet and opined that the condition was less likely than not incurred in or caused by claimed in-service injury, event, or illness. The examiner noted the April 1969 report of medical history at service separation shows that the Veteran reported foot trouble (athletic feet) and explained that this condition is not equivalent to the current foot condition. The examiner further explained that there was no other indication that the current bilateral foot disability developed during service. The March 2018 examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, at 304. There are no medical opinions to the contrary. The Veteran believes that his right and left foot disabilities are related to service. While the Veteran was competent to report symptoms of a bilateral foot disability, such as pain, he was not competent to provide a nexus opinion with respect to the etiology of his disability. The issue is medically complex, as it requires knowledge of the musculoskeletal system and the development of metatarsalgia years after service, as well as whether metatarsalgia is related to in-service complaints of athletic feet. The record does not show that the appellant or the Veteran has or had the medical training or experience necessary to make such a determination. Jandreau, at 1377 n.4; see also Kahana, 24. Vet. App. 428. In the absence of any competent and probative evidence of record indicating that the Veteran's right and left foot disabilities may be associated with a disease or injury in service, the Board must find that the preponderance of the evidence is against the claim. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The appeal of these issues must be denied. EFFECTIVE DATE Generally, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date upon receipt of new and material evidence after a final disallowance will be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2). When there is a prior final decision in the claims file and a later reopened claim results in a grant of the benefit, the general rule for effective dates for reopened claims applies. In such cases the effective date cannot be earlier than the subsequent claim to reopen. 38 C.F.R. §§ 3.400(q)(2), 3.400(r); Leonard v. Principi, 17 Vet. App. 447, 452 (2004); Sears v. Principi, 16 Vet. App. 244, 246-50 (2002), aff'd,349 F.3d 1326 (Fed. Cir. 2003). Under regulations applicable prior to March 24, 2015, any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. An informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (2014). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). Under current regulation, the term "claim" means a written communication requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit under the laws administered by VA submitted on an application form prescribed by the Secretary. 38 C.F.R. § 3.1(p). 1. Entitlement to an effective date prior to November 15, 2011 for the award of service connection for lumbar spine degenerative disc disease is denied. The Veteran requests an effective date prior to November 15, 2011 for the award of service connection for degenerative disc disease of the lumbar spine. A February 2004 rating decision denied service connection for a lumbar spine disability. A letter dated that same month notified the Veteran of this decision and how to appeal. VA received no appeal within a year, and no new evidence; as such, this decision became final. 38 U.S.C. § 7105 (b), (c); 38 C.F.R. §§ 3.160(d), 20.201, 20.302, 20.1103. On November 15, 2011, VA received an application to reopen the previously denied claim for this disability; the claim was reopened, and the RO granted service connection. The Board concludes that here the effective date of the award of compensation based on a reopened claim after final disallowance is by law the date of receipt of the claim. 38 U.S.C. § 5110(a); 38 C.F.R. §§ 3.400, 3.400(q)(2). The Veteran's representative advanced that asserts that a notice of disagreement with the February 2004 rating decision was filed on March 1, 2004, and that the Veteran has continuously prosecuted his lumbar spine claim since August 18, 2003. See April 2021 representative statement. There is a presumption of regularity under which it is presumed that government officials "have properly discharged their official duties." United States v. Chemical Foundation, Inc., 272 U.S. 1, 14-15 (1926); Mindenhall v. Brown, 7 Vet. App. 271, 274 (1994) (VA need only mail notice to the last address of record for the presumption to attach). This presumption of regularity in the administrative process may be rebutted by "clear evidence to the contrary." Schoolman v. West, 12 Vet. App. 307, 310 (1999); see also Ashley v. Derwinski, 2 Vet. App. 307 (1992) (quoting United States v. Chemical Foundation, 272 U.S. 1, 14-15 (1926)). A claimant's mere statement that he submitted a document to VA is insufficient for that purpose. Fithian v. Shinseki, 24 Vet. App. 146, 151 (2010). In this case, there is no clear evidence that VA ever received a notice of disagreement in response to the February 2004 rating decision. No document resembling a notice of disagreement with the February 2004 rating decision is associated with the file until he filed his application to reopen his service connection claim in November 2011. No letter acknowledging receipt of a notice of disagreement was sent, nor were any notations of an appeal made in the file. Further, there is no evidence that any documents received by the RO have been ignored or destroyed. As such, the only evidence of record indicating that a notice of disagreement was misplaced or not acted upon is the representative's assertions, which are insufficient on their own to rebut the presumption or regularity. Fithian, 24 Vet. App. at 151. The Veteran has not otherwise identified nor has the Board's review of the record disclosed a formal or informal claim for benefits, prior to November 15, 2011, and after the RO's February 2004 final decision. See 38 C.F.R. §§ 3.1(p), 3.155(a); see also Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have intent to file a claim for VA benefits). Here, the RO obtained an examination in December 2014 that yielded a positive nexus opinion as to the current lumbar spine disability. Thus, the RO in March 2015 found evidence of a nexus between service and a current disability, which was the basis of the prior denial, and reopened and granted the claim. The record provides no basis for an award of service connection prior to November 15, 2011. Accordingly, the claim for an effective date earlier than November 15, 2011, for lumbar spine degenerative disc disease is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). 2. Entitlement to an effective date prior to November 15, 2011 for the award of service connection for left lower extremity radiculopathy is denied. The Veteran requests an effective date prior to November 15, 2011 for the award of service connection for left lower extremity radiculopathy as secondary to degenerative disc disease of the lumbar spine. While the Veteran has requested an earlier effective date, he has not indicated why an earlier effective date is warranted. As noted above, a February 2004 rating decision denied service connection for a lumbar spine disability. A letter dated that same month notified the Veteran of this decision and how to appeal. VA received no appeal, and no new evidence within a year; as such, this decision became final. 38 U.S.C. § 7105(b), (c); 38 C.F.R. §§ 3.160(d), 20.201, 20.302, 20.1103. On November 15, 2011, VA received a claim to reopen the previously denied claim for a lumbar spine disability; the claim was reopened, and the RO granted service connection. Examination of the Veteran in December 2014 showed left lower extremity radiculopathy, for which service connection was granted in a December 2017 rating decision. The RO granted service connection effective November 15, 2011, the date the Veteran's application to reopen the claim for service connection for a lumbar spine disability was received. The effective date of the secondary disability cannot be earlier than the effective date for the primary disability based on which secondary service connection was granted. The record does not otherwise provide any basis for an award of service connection prior to the date the Veteran's application to reopen his claim for lumbar spine disability was received. An effective date earlier than November 15, 2011, for left lower extremity radiculopathy is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). REASONS FOR REMAND Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's remaining claims and to afford him every possible consideration. 1. Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicide agents during service, is remanded. 2. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents during service, is remanded. 3. Entitlement to service connection for renal cell carcinoma, to include as due to exposure to herbicide agents during service, is remanded. 4. Entitlement to service connection for a skin disability, to include as due to exposure to herbicide agents during service, is remanded. The Veteran contends he was exposed to herbicides in service while stationed in Korea. See March 2013 correspondence. Upon review of the Veteran's claim file, the Board notes that the appropriate development has not been completed regarding the Veteran's claim of exposure. See 38 C.F.R. § 3.307(a)(6)(iv). VA has determined that additional development action is warranted when a Veteran was not specifically assigned to one of several enumerated units but alleges exposure in Korea. See M21-1MR, Part IV, subpart ii, Chapter 1, Section H, VA Adjudication and Procedures Manual. Specifically, the Agency of Original Jurisdiction (AOJ) must send a request to the U.S. Army and Joint Services Records Research Center (JSRRC) for verification of exposure to herbicides. The Veteran's description of herbicide exposure in the Korean DMZ, was not sent to the JSRRC for verification. During the pendency of this appeal, the Veteran has provided specific details regarding his activities throughout Korea, to include in the vicinity of the Korean DMZ. See March 2013 Veteran statement. As such, the Board finds that these claims must be remanded to refer the Veteran's description of herbicide exposure to the JSRRC. 5. Entitlement to service connection for peripheral neuropathy is remanded. The Veteran asserts his peripheral neuropathy is due to or caused by his diabetes mellitus. See November 2011 VA Form 21-526b. The issue of the Veteran's entitlement to service connection for peripheral neuropathy is inextricably intertwined with the issue of entitlement to service connection for diabetes mellitus. See, e.g., Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 2 Vet. App. 180, 183 (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on an appellant's claim for another issue). As such, the Board will remand the claim for service connection for peripheral neuropathy as well. 6. Entitlement to service connection for residuals of a jaw fracture is remanded. The Veteran contends that he developed a jaw fracture in service or as a result of his service, specifically tooth extraction. See February 2004 statement; see also January 2014 statement. As to evidence of in-service injury or disease, the Veteran's service treatment records refect dental treatment for carious teeth, but do not show a jaw fracture. However, the Board notes that an August 1969 award letter shows service connection was granted for his teeth. In light of the Veteran's assertion of a relationship between current jaw fracture residuals and service, and the fact he has not been examined, the Board finds that a VA examination is warranted. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board also notes medical records from the Fresno VA Hospital are not associated with his claims file and that the Veteran reported he underwent tooth extractions at this facility shortly after discharge. See February 1970 Correspondence. VA treatment records are considered within VA's constructive possession and should be obtained on remand. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). 7. Entitlement to an effective date prior to February 5, 2018 for the award of service connection for radiculopathy of the right lower extremity is remanded. An April 2018 rating decision granted service connection for radiculopathy of the right lower extremity and assigned a 10 percent rating effective February 5, 2018. In May 2018, the Veteran submitted a notice of disagreement (NOD) on a standard form in response to the April 2018 rating decision as to the effective date assigned for service connection for radiculopathy of the right lower extremity. To date, no statement of the case (SOC) as to this issue has been furnished. In Manlincon v. West, 12 Vet. App. 238 (1999), the United States Court of Appeals for Veterans Claims (Court) held that when an appellant files a timely NOD as to a particular issue, and no SOC is furnished, the Board should remand, rather than refer, the case for the issuance of an SOC. 8. Entitlement to a TDIU is remanded. The Veteran's claim for TDIU is inextricably intertwined with the claims that are being remanded. See, e.g., Parker, 7 Vet. App. 116; Harris, 2 Vet. App. at 183. As such, the Board will remand the TDIU claim as well. The matters are REMANDED for the following action: 1. Obtain all updated relevant treatment records and associate them with the claims file. Specifically request all VA medical and dental treatment records from May 1969 to the present from the VA Hospital in Fresno. 2. Send a request to JSRRC for verification of the Veteran's exposure to herbicides. Inquire as to whether the Veteran's unit (Admin Company, Headquarters, 2nd Infantry) served near the DMZ, taking into account the details of the Veteran's account of service near Camp Ross and Camp Howze. All attempts to secure this evidence must be documented in the claims file. 3. Schedule the Veteran for an appropriate VA examination to determine the current nature and likely etiology of any current residuals of a jaw fracture, to include any dental manifestations. Copies of all pertinent records should be forwarded to the examiner for review. All indicated testing should be carried out. Based on the examination and review of the record, the examiner should offer an opinion as to the following: (a) Does the Veteran have any current residuals of a jaw fracture? (b) If there are current residuals, is it at least as likely as not (50 percent or higher degree of probability) that the current residuals were caused by trauma in service? (c) Is there loss of substance of the maxilla or mandible? (d) If the Veteran has loss of substance of the maxilla or mandible, is it at least as likely as not (50 percent or higher degree of probability) that the loss was caused by trauma in service? The examiner should consider, and discuss as necessary, the Veteran's in-service dental history. A complete rationale for all opinions expressed must be provided. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues remaining on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Stephanie M. Owen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Ragheb, 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.