Citation Nr: 21042090 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-60 454 DATE: July 12, 2021 ORDER New and material evidence having been submitted, the service connection claim for a migraine headache disorder is reopened. New and material evidence having been submitted, the service connection claim for a right hand disorder is reopened. New and material evidence having been submitted, the service connection claim for a right knee disorder is reopened. New and material evidence having been submitted, the service connection claim for a left knee disorder is reopened. New and material evidence having been submitted, the service connection claim for a low back disorder is reopened. New and material evidence having been submitted, the service connection claim for a right foot disorder is reopened. Service connection for a lumbar spine disorder, namely lumbar degenerative joint disease, is granted. Service connection for a right knee disorder, namely right chondromalacia patella, is granted. Service connection for a left knee disorder, namely left chondromalacia patella, is granted. Service connection for a right foot disorder, namely right plantar fasciitis, is granted. Service connection for a left foot disorder, namely left plantar fasciitis, is granted. Service connection for a right hand disorder is denied. Service connection for a disorder manifested by ulcers is denied. An initial compensable rating for bilateral hearing loss is denied. An effective date prior to September 18, 2015 for the grant of service connection for bilateral hearing loss is denied. An effective date prior to September 18, 2015 for the grant of service connection for tinnitus is denied. REMANDED Service connection for a migraine headache disorder is remanded. Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), bipolar disorder, major depressive disorder, and an antisocial personality disorder, is remanded. FINDINGS OF FACT 1. In a final decision issued in March 1999, the Regional Office (RO) denied the Veteran's claims seeking service connection for headache, psychiatric, right hand, low back, and bilateral knee disorders. 2. Evidence associated with the record since this prior final decision is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the Veteran's claims of entitlement to service connection for headache, psychiatric, right hand, low back, and bilateral knee disorders. 3. The Veteran incurred his current lumbar degenerative joint disease as a result of service. 4. The Veteran incurred his current right chondromalacia patella as a result of service. 5. The Veteran incurred his current left chondromalacia patella as a result of service. 6. The Veteran incurred his current right plantar fasciitis as a result of service. 7. The Veteran incurred his current left plantar fasciitis as a result of service. 8. At no time during the pendency of the claim does the record contain a current disability of a right hand disorder, and the record does not contain a recent diagnosis of such a disability prior to the Veteran's filing of a claim. 9. The evidence fails to establish that the Veteran developed a disorder manifested by ulcers during or as a result of service. 10. During the instant rating period, the Veteran's bilateral hearing acuity has been assessed as equating to Level II in both ears. 11. The Veteran did not file a formal or informal claim for service connection for bilateral hearing loss or tinnitus prior to the receipt of his original claim on September 18, 2015. CONCLUSIONS OF LAW 1. The March 1999 administrative decision that denied the Veteran's initial service connection claims for headache, psychiatric, right hand, low back, bilateral knee disorders is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 2. New and material evidence has been received to reopen the claims of entitlement to service connection for headache, psychiatric, right hand, low back, and bilateral knee disorders. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria have been met for service connection for lumbar spine degenerative joint disease. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria have been met for service connection for a right chondromalacia patella. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria have been met for service connection for a left chondromalacia patella. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria have been met for service connection for a right plantar fasciitis. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria have been met for service connection for a left plantar fasciitis. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria have not been met for service connection for a right hand disorder. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria have not been met for service connection for a disorder manifested by ulcers. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria have not been met for an initial compensable rating for bilateral hearing loss. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 11. The criteria have not been met for an effective date prior to September 18, 2015 for the grant of service connection for tinnitus. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 12. The criteria have not been met for an effective date prior to September 18, 2015 for the grant of service connection for bilateral hearing. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1993 to June 1998. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2016 by a Regional Office (RO) of the Department of Veterans Affairs (VA). New and Material Evidence 1. New and material evidence has been received to reopen a service connection claim for a migraine headache disorder. 2. New and material evidence has been received to reopen a service connection claim for a psychiatric disorder. 3. New and material evidence has been received to reopen a service connection claim for a right hand disorder. 4. New and material evidence has been received to reopen a service connection claim for a low back disorder. 5. New and material evidence has been received to reopen a service connection claim for a left knee disorder. 6. New and material evidence has been received to reopen a service connection claim for a right knee disorder. Legal Criteria Generally, when a claim is disallowed, it may not be reopened and allowed, and a claim based on the same factual basis may not be considered. 38 U.S.C. § 7105. However, a claim on which there is a final decision may be reopened if new and material evidence is submitted. 38 U.S.C. § 5108. "New" evidence means existing 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). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003). The requirement of new and material evidence raising a reasonable possibility of substantiating the claim is a low threshold. Specifically, 38 C.F.R. § 3.156(a) creates a low threshold, and the phrase "raises a reasonable possibility of substantiating the claim" enables, rather than precludes, reopening. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Factual Background The Veteran filed a claim in July 1998 seeking service connection for headache, psychiatric, right hand, low back, and bilateral knee disorders. The record reflects that the Veteran's service personnel and treatment records were then obtained to review in conjunction with his claims for benefits. However, given the character of the Veteran's "other than honorable" discharge from service, the RO determined that the nature of the Veteran's discharge was a bar to VA benefits, and the RO denied the Veteran's claims, as reflected in a decision issued in March 1999, which was accompanied by an advisory of the Veteran's appellate rights. The Veteran did not appeal this decision, and no evidence relevant to the claim was received within the year after its issuance, thereby rendering this March 1999 decision final. The Veteran filed claims seeking to reopen these previously denied service connection claims for headache, psychiatric, right hand, low back, and bilateral knee disorders in September 2015. In support of these claims, he submitted evidence in the form of lay statements authored by fellow service members and provided testimony regarding the circumstances of his discharge from service, all to support his contention that his in-service behavior that culminated in his discharge from service was not indicative of a pattern of willful and persistent misconduct. Based on this evidence, the RO agreed that the Veteran's in-service violations failed to reflect a pattern of willful, persistent misconduct and concluded that the evidence of record reflects that apart from these violations, the Veteran's service was otherwise honest, faithful and meritorious. As such, the RO issued a decision in April 2016 determining that the Veteran's character of discharge was not a bar to VA compensation benefits and thereafter adjudicated the Veteran's service connection claims in the June 2016 rating decision on appeal. Analysis Given the foregoing, the Board finds that the evidence of record establishes that the Veteran's character of discharge is no longer a bar to benefits, and this evidence relates directly to the reason the Veteran's service connection claims were initially denied. As such, the evidence of record is new and material, sufficient to reopen his previously denied service connection claims for headache, psychiatric, right hand, low back, and bilateral knee disorders. These reopened claims will be further addressed below. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. §§ 1101, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain disabilities, including arthritis, are presumed to be serviced connected if they manifest to a compensable degree within one year following service. 38 C.F.R. §§ 3.303, 3.307, 3.309. 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, 53 (1990). 1. Service connection for a low back disorder is granted. 2. Service connection for a right knee disorder is granted. 3. Service connection for a left knee disorder is granted. 4. Service connection for a right foot disorder is granted 5. Service connection for a left foot disorder is granted. As there is considerable overlap in the applicable evidence for the Veteran's claims, the Board will discuss them together. Factual Background The Veteran asserts that he incurred multiple orthopedic disorders, namely back, knee, and foot disorders, as a result of his physical training and duties during his service in the Marine Corps, to include lengthy road marches while carrying heavy equipment. Indeed, during service, the Veteran sought treatment for back, knee, and foot pain. Concerning the Veteran's in-service back treatment, in early April 1994, the Veteran sought treatment for back pain, reporting that he twisted his back one day prior while playing basketball, and he was assessed with a muscle strain of the left side of the latissimus dorsi. Later in April 1994, the Veteran again sought treatment for mid-back pain, reporting that he had been experiencing symptoms for the past one and a half weeks, and he was assessed with a spasm/musculoskeletal pain. In June 1994, the Veteran again reported experiencing back pain, and he was assessed with a lumbar strain. In November 1994, the Veteran reported experiencing pain in his mid-lower back in the sagittal aspect of his right side for two years, and his complaints were assessed as muscular back spasms. In April 1998, while undergoing psychiatric treatment, the Veteran reported experiencing back pain, but his back was assessed as normal on clinical examination. When completing an April 1998 medical history report, the Veteran again reported a history of low back pain. In November 1998, the Veteran reported a two-year history of back pain, which was assessed as mechanical low back pain/muscular spasm. Concerning the Veteran's in-service knee treatment, in May 1996, the Veteran sought treatment for left knee pain and evidenced limited left knee range of motion and pain on movement, and was assessed with a left knee strain and prescribed medication and physical therapy. In October 1996, the Veteran again complained of left knee pain, and on examination, the Veteran demonstrated full left knee range of motion but with a patella grind, and he was assessed with patellofemoral pain syndrome. In June 1997, the Veteran sought treatment for bilateral knee pain, but the Veteran's knees were assessed as essentially normal on examination. In September 1997, the Veteran reported a long history (18 months) of bilateral knee pain. In December 1997, the Veteran again reported experiencing knee pain for one and half years, and it was noted that he had been diagnosed with patellofemoral pain syndrome twice. X-rays taken at this time were deemed normal, and the Veteran was assessed with status post-vastus medialis obliquus weakness and was prescribed physical therapy. When completing an April 1998 separation medical history report, the Veteran reported a history of knee pain. Concerning the Veteran's in-service foot treatment, the Veteran reported experiencing right foot pain in September 1997, and x-rays of right foot taken at this time were deemed normal. When completing an April 1998 separation medical history report, the Veteran reported a history of his right foot popping. Following service, the Veteran sought service connection for back and knee disorders in July 1998, but as referenced above, based on the VA determination that he was ineligible for VA compensation benefits, his claims were denied. The next reference to these disorders of record (and the first reference to foot disorders) is reflected in the September 2015 claims, from which this appeal arises. During his May 2016 VA back, knee and foot examinations, the Veteran reported that he had experienced continuous back, knee and foot impairments since service but did not seek related treatment, with the exception for knee treatment in 2012 at which time he recalled being diagnosed with bilateral knee arthritis. However, no arthritis was detected during the Veteran's back, knee and foot examinations, although degenerative lumbar spine changes were subsequently detected in a January 2018 VA magnetic resonance imaging (MRI) study. At the time of the May 2016 VA examinations, the Veteran was diagnosed with a lumbosacral strain, bilateral knee strain, and bilateral plantar fasciitis, although subsequent medical evidence of record reflects that the Veteran's current disorders are more accurately characterized as lumbar spine degenerative joint disease, bilateral knee chondromalacia patella, and bilateral pes planus. The VA examiner who conducted the May 2016 orthopedic examinations concluded that the Veteran's current back, knee and foot disorders were unrelated to service, determining that the Veteran's related in-service ailments represented acute and transitory impairments that fully resolved during service. However, the Board finds these May 2016 VA medical opinions to be legally inadequate, as they failed to consider the Veteran's reports of back, knee and foot impairments on separation from service, that the Veteran initially sought service connection for back and knee impairments soon after his separation from service, or the Veteran's own competent, credible reports of experiencing continuous symptoms since service. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (holding that to have probative value, the opinion provider must be fully informed of the pertinent factual premises, provide a fully articulated opinion, and provide a supportive reasoned analysis); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Veteran, through his attorney, has submitted a comprehensive medical opinion, based on a full and accurate medical history, authored in May 2020 by a physician with extensive orthopedic expertise. In this May 2020 opinion, the private physician chronicled his comprehensive review of the Veteran's medical history and concluded that the nature of the Veteran's current back, knee, and foot disorders was consistent with a conclusion that these disorders developed during service, likely as a result of the stress incurred by the Veteran's strenuous Marine Corps physical training, requiring him to carry heavy loads (with as much as 75 pounds of equipment) on extended marches. The physician noted that the strain incurred on the Veteran from such activities would be especially great, given his relatively small frame (the Veteran was noted to be five feet six inches tall and 120 pounds on entrance to service), as evidenced by his frequent in-service orthopedic treatment. Further, the physician cited studies supporting a theory that the Veteran's current back, knee and foot disorders were a natural progression of his in-service complaints, both documented and undocumented, as the Veteran reported that the stoic culture of the Marine Corps dissuaded him from seeking medical treatment for his ailments more regularly. Likewise, the physician stated that the February 2017 VA lumbar spine and bilateral knee MRI findings of a prior annulus tear and patella tears and arthritis were consistent with a progression of the Veteran's low back impairments and patellofemoral pain syndrome documented during service. Analysis The Board affords great probative weight to the May 2020 private opinion concluding that the Veteran developed his current back, knee and foot disorders as a result of service, as this opinion considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided complete rationales, relying on and citing to the records reviewed. Moreover, the opinions contain clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). As the more probative evidence of record supports a finding that the Veteran's current lumbar spine, bilateral knee, and bilateral foot disorders are related to service, the Board finds that a basis for granting service connection has been presented. In reaching this decision, the Board has applied the benefit of the doubt doctrine and applied it in the Veteran's favor. 6. Service connection for a right hand disorder is denied. Factual Background The Veteran asserts that he has a current right hand disorder resulting from his in-service hand injuries and finger fractures, for which he sought contemporaneous treatment documented in his service treatment records. However, while the evidence of record shows that the Veteran sustained right hand trauma during service, the record fails to show that the Veteran has a current right hand disability. The Veteran was afforded a VA hand examination in May 2016, during which the Veteran recounted his perception of experiencing a right hand impairment since his in-service injuries; however, no indications of any right hand functional impairment were observed during a clinical examination of his right hand. Specifically, the Veteran demonstrated full range of motion of all right hand fingers and thumb, with no pain exhibited on range of motion testing, and the examiner accordingly concluded that there was no objective evidence of functional loss. Further, x-rays of the Veteran's right hand revealed no abnormalities. Moreover, the Veteran's subsequent VA treatment records following this examination fail to reference any right hand impairment. Analysis The Board has not overlooked the Veteran's lay statements regarding his claimed right hand disorder. The Veteran is competent (qualified) to report on observable factual matters of which he had firsthand knowledge; and the Board finds that the reports concerning his symptoms are credible. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, there is no basis for concluding that a lay person is competent to discern whether any given symptoms constitute a diagnosis, or is related to service, in the absence of specialized medical training, which in this case has not been established. 38 U.S.C. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Because of this, the objective medical findings and opinions provided by the May 2016 examiner has been accorded greater probative weight in determining that service connection is not warranted. There is no competent medical evidence showing a diagnosis of a right hand disorder, or functional loss of the right hand, during the appeal period. The most fundamental requirement for any claim for service connection, on either a direct or secondary basis, is that the Veteran must first establish he or she has the condition claimed. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328 (1997); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In other words, the evidence must show that, at some point during the appeal period, the Veteran has the disabilities for which benefits are being claimed. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Based on the above analysis, the preponderance of the evidence is against the claim. The benefit-of-the-doubt rule does not apply, and service connection for a right hand disorder must be denied. 7. Service connection for a disorder manifested by ulcers is denied. With regard to the Veteran's claim seeking service connection for a disorder manifested by ulcers, referred to by the Veteran simply as "ulcers," neither the Veteran nor his attorney have made any specific assertions as to the nature of the Veteran's claimed ulcer disorder or its potential relationship to service. Further, while the Veteran's VA treatment of record indicated he has been diagnosed with gastroesophageal reflux disease (GERD), a gastrointestinal disorder that can be associated with stomach ulcers, there is no documentation of any in-service related treatment for this condition, nor has the Veteran reported any related in-service symptoms. Accordingly, the record as a whole fails to suggest any connection between a current disorder manifested by ulcers and service. As such, the preponderance of the evidence is against the Veteran's claim; there is no reasonable doubt to be resolved on the Veteran's behalf, and service connection for a disorder manifested by ulcers is not warranted. Increased Rating Claim Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where 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. See 38 C.F.R. § 4.7. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Legal Criteria A disability rating for hearing loss is determined by a mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. The rating schedule establishes eleven acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI for profound deafness. VA audiometric examinations are conducted using a controlled speech discrimination test (Maryland CNC) together with the results of a pure tone speech audiometry test. In 38 C.F.R. § 4.85, the vertical lines of Table VI represent nine categories of the percentage of discrimination based on the controlled speech discrimination test, whereas the horizontal columns of Table VI represent nine categories of decibel loss based on the pure tone audiometry test. Id. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the pure tone decibel loss. Id. The percentage disability evaluation is then found from Table VII of 38 C.F.R. § 4.85, by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate to the numeric designation level for the ear having the poorer hearing acuity. Id. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). Factual Background The Veteran asserts that his service-connected sensorineural hearing loss is more severe than the assigned noncompensable (0 percent) rating. 38 C.F.R. § 4.85, Diagnostic Code 6100. The only audiological evidence from the rating period was obtained during the Veteran's June 2016 VA audiological examination. In that regard, while subsequent VA audiological treatment records reflect the Veteran's fitting for hearing aids, no audiological data was recorded in the treatment reports. The June 2016 VA audio examination report revealed the following pure tone thresholds, in decibels: HERTZ AVG 1000 2000 3000 4000 RIGHT 29 15 30 30 40 LEFT 16 5 20 20 20 These results failed to reveal any exceptional pattern of hearing loss. Speech audiometry testing revealed speech recognition scores of 88 percent in both ears. These hearing impairment findings correspond to Level II in the right ear and Level II in the left ear, under Table VI. 38 C.F.R. § 4.85. Intersecting Levels II and II under Table VII results in a noncompensable rating. 38 C.F.R. § 4.85, DC 6100, Table VII. During the examination, the Veteran reported experiencing decreased speech recognition and overall impaired hearing, resulting in misunderstandings and requiring him to read lips and increase the volume when watching television programs. To the extent that the Veteran contends that his bilateral hearing loss is more severe than currently evaluated, the Board observes that the Veteran, while competent to report symptoms capable of lay observation, to include difficulty understanding speech in person or on television, causing feelings of frustration, is not competent to report that his hearing acuity is of sufficient severity to warrant a rating higher than the rating assigned under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Based on the above analysis, at no time during the appellate period has the Veteran's bilateral sensorineural hearing loss more closely approximated a compensable disability rating pursuant to VA regulations. 38 C.F.R. § 4.85, DC 6100. The Board acknowledges the Veteran's assertions that his hearing has worsened, affects his daily living and functional ability, and that he should be entitled to a greater disability rating than the assigned noncompensable rating. See Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In this regard, the Board finds the Veteran fully credible, but also finds the Veteran's subjective reports and the functional effects described by his examiner to be fully consistent with the degree of audiological impairment shown upon examination. The Board finds that the June 2016 VA examination report, finding that the Veteran's service-connected hearing loss more closely approximated a noncompensable rating, is the most probative evidence of record, as the examiner reviewed the claims file and provided a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). While the Veteran is competent to observe his hearing loss symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluations concerning his hearing loss. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Because of this, the preponderance of the evidence is against the Veteran's increased rating claim for bilateral hearing loss. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Earlier Effective Dates 1. Entitlement to an effective date prior to September 18, 2015 for the grant of service connection for bilateral hearing loss is denied. 2. Entitlement to an effective date prior to September 18, 2015 for the grant of service connection for tinnitus is denied. As there is considerable overlap in the applicable evidence for the Veteran's claims, the Board will discuss them together. Legal Criteria Unless otherwise provided, the effective date for an award of compensation for service-connected disability shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefor. The effective date 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. Factual Background and Analysis The Veteran alleges that the effective dates for his service-connected bilateral hearing loss and tinnitus should be earlier than September 18, 2015. On September 18, 2015, the Veteran submitted a formal claim for entitlement to service connection for bilateral hearing loss and tinnitus. In June 2016 rating decision, the RO granted service connection for hearing loss and tinnitus, assigning a noncompensable rating for hearing loss, and a 10 percent rating for tinnitus, effective September 18, 2015, the date of the Veteran's service connection claim. In a February 2017 Notice of Disagreement, the Veteran disagreed with the effective dates of his service-connected bilateral hearing loss and tinnitus. Neither the Veteran nor his attorney have made any specific assertions regarding what date they would like service connection to be granted. Prior to his September 18, 2015 formal claim for service connection, the Veteran made no submission to VA which may be construed as a formal or informal claim for service connection for bilateral hearing loss and tinnitus. The Veteran does not allege that he filed such claims prior to this date. The Veteran filed previous claims for service connection for headache, psychiatric, and various orthopedic disorders, but made no mention of audiological disorders in these claims. No such submission demonstrated an intent to apply for benefits for service connection for bilateral hearing loss or tinnitus prior to September 18, 2015. There is no informal or formal claim any time prior to September 18, 2015. It is not legally possible for the grant of service connection to be any earlier than the current effective date of September 18, 2015. According to 38 C.F.R. § 3.400, the effective date of an award of compensation based on an original claim, "will be the date of receipt of the claim or the date entitlement arose, whichever is the later" (emphasis added). Because the Veteran did not submit his formal claim for service connection until September 18, 2015, that is the earliest effective date that service connection can be granted. Id. REASONS FOR REMAND 1. Entitlement to service connection for a migraine headache disorder is remanded. The Veteran reports that the onset of his current migraine headache disorder began during service, and his service treatment records reflect that he sought treatment for a headache, diagnosed as a migraine headache, during service, and reported a history of headaches when completing his separation medical history report. The Veteran also reported experiencing headaches, among other symptoms, when seeking treatment for a viral infection and as a side effect of his prescribed psychiatric medication. However, the negative VA opinion rendered in May 2016 in conjunction with the Veteran's VA headaches examination failed to consider the Veteran's competent reports of continuity of headache symptoms since service, and is therefore legally inadequate. Accordingly, a new opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). 2. Entitlement to service connection for a psychiatric disorder is remanded. The Veteran is seeking service connection for a psychiatric disorder which he asserts he developed during service. The Veteran's service treatment records reflect that he received extensive psychiatric treatment during service, thereby suggesting a potential in-service onset. However, while a June 2016 VA medical opinion and a May 2020 private opinion address this potential nexus to service, neither employ the appropriate legal standard to address the evidence of record indicating that the Veteran's psychiatric disorder either preexisted service or is attributable to pre-service psychological stressors. In that regard, the June 2016 VA psychiatric examination reflects a diagnosis of an antisocial personality disorder (also diagnosed during service) as well as a diagnosis of PTSD, based on stressors from both prior to and during service. However, the examiner concluded that the Veteran's pre-service stressors were of such significance that his subsequent in-service stressor did not contribute to his current PTSD. Notably, this opinion failed to consider whether this reported in-service stressor (of nearly drowning during a training exercise) exacerbated a preexisting psychiatric disorder or compounded pre-service stressors so as to trigger the subsequent development of PTSD. Additionally, the opinion failed to address potential aggravation of the Veteran's congenital personality disorder. Further, the May 2020 private opinion, which relates the onset of diagnosed major depressive disorder and schizophrenia to service, concludes that the Veteran had no significant pre-service trauma or psychiatric symptoms, thereby failing to contribute to the development of his current psychiatric disorders. However, this finding is contradicted by the Veteran's own reports during service of extensive pre-service psychological trauma, as chronicled in psychiatric assessments. As such, new VA medical opinions, considering the entirety of the relevant evidence of record, and utilizing the appropriate legal standards, must be obtained. See id. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's current migraine headache disorder is at least as likely as not (a 50 percent or greater probability) related to service. When rendering this opinion, the clinician must consider the Veteran's report of experiencing a headache, among other symptoms, in July 1995; treatment for a migraine headache during service in June 1996; a report of a headache in reaction to his psychiatric medication in June 1997; the Veteran's reports of a history of headaches on his April 1998 separation medical history report; the Veteran's initial service connection claim for a headache disorder soon after service in July 1998; and the Veteran's competent credible report of experiencing recurrent migraine headache episodes since service. 2. Obtain a medical opinion from an appropriate clinician regarding whether the Veteran's acquired psychiatric disorders, variously diagnosed during the appeal period as PTSD, schizophrenia, and a major depressive disorder, are at least as likely as not related to service. After reviewing the evidence of record, to specifically include the Veteran's in-service psychiatric treatment and contemporaneous reports of significant pre-service psychological stressors, the clinician is asked to opine whether any of the Veteran's acquired psychiatric disorders diagnosed during the rating period (PTSD, schizophrenia, and major depressive disorder) clearly and unmistakably (undebatably) preexisted the Veteran's service. If the clinician finds that any of these acquired psychiatric disorders clearly and unmistakably preexisted service, the clinician should opine whether they clearly and unmistakably were *not* aggravated by service. If the clinician finds that any of the Veteran's current acquired psychiatric disorders either did not clearly and unmistakably preexist service, or were not clearly and unmistakably aggravated by service, the clinician must opine whether it at least as likely as not (a 50 percent or greater probability) that these psychiatric disorders are related to service, including the Veteran's reported in-service psychological stressors of relationship stress or a near drowning event that reportedly occurred during training. With regard to the Veteran's diagnosed antisocial personality disorder, diagnosed both during and after service, the clinician is asked to opine whether it is at least as likely as not that any current acquired psychiatric disorder were superimposed on a personality disorder during active service, which in turn resulted in an additional disability. 3. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). J. Abrams Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Northcutt, 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.