Citation Nr: 18160386
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 18-30 977
DATE:	December 26, 2018
ORDER
An evaluation in excess of 40 percent for service-connected lumbar myositis with herniated nucleus pulposus, degenerative arthritis, and lumbar strain, is denied.
An initial evaluation in excess of 10 percent for service-connected left lower extremity radiculopathy is denied.
An initial evaluation in excess of 10 percent for service-connected right lower extremity radiculopathy is denied.
An evaluation in excess of 10 percent for service-connected right ankle contracture is denied.
A compensable evaluation for service-connected right foot plantar callus is denied.
An effective date of April 25, 2016, for the award of service connection for left lower extremity radiculopathy is granted.
An effective date of April 25, 2016, for the award of service connection for right lower extremity radiculopathy is granted.
Entitlement to an effective date earlier than January 20, 2000, for the assignment of a 40 percent disability rating for the service-connected lumbar myositis is dismissed.
REMANDED
Entitlement to service connection for a left hip disorder is remanded.
Entitlement to service connection for a right hip disorder is remanded.
Entitlement to service connection for a left knee disorder is remanded.
Entitlement to service connection for a right knee disorder is remanded.
Entitlement to service connection for a cervical spine disorder is remanded.
Entitlement to service connection for a left foot disorder is remanded.
Entitlement to service connection for a psychiatric disorder, to include anxiety, depression, and posttraumatic stress disorder (PTSD), is remanded.
FINDINGS OF FACT
1. The service-connected low back disability is not manifested by unfavorable ankylosis of the entire thoracolumbar spine or by incapacitating episodes of intervertebral disc syndrome having a total duration of at least six weeks during the preceding 12 months. 
2. The service-connected left lower extremity radiculopathy has most nearly approximated mild incomplete paralysis of the sciatic nerve, but not moderate incomplete paralysis.
3. The service-connected right lower extremity radiculopathy has most nearly approximated mild incomplete paralysis of the sciatic nerve, but not moderate incomplete paralysis. 
4. The service-connected right ankle contracture is manifested by no more than moderate limitation of motion.
5. The service-connected right plantar callus manifests less than five percent of the entire body or exposed areas affected, and requires no medical therapy during the preceding 12-month period.
6. In April 2016, the Veteran filed a claim of service connection for sciatic neuropathy of the left and right lower extremities. 
7. The Veteran’s February 2018 statement constitutes a freestanding claim for an effective date earlier than January 20, 2000, for the assignment of a 40 percent disability rating for the service-connected lumbar myositis, which is barred as a matter of law. 
CONCLUSIONS OF LAW
1. The criteria for a disability rating greater than 40 percent for service-connected lumbar paravertebral myositis with herniated nucleus pulposus, degenerative arthritis, and lumbar strain, have not been met.  38 U.S.C. § 1155, 5103, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5021, 5243. 
2. The criteria for an initial disability rating greater than 10 percent for service-connected left lower extremity radiculopathy have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520.
3. The criteria for an initial disability rating greater than 10 percent for service-connected right lower extremity radiculopathy have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520.
4. The criteria for a disability rating greater than 10 percent for service-connected right ankle contracture have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5271.
5. The criteria for a compensable disability rating for service-connected right plantar callus have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7806.
6. The criteria for an effective date of April 25, 2016, for the assignment of a separate 10 percent disability rating for service-connected left lower extremity radiculopathy have been met.  38 U.S.C. §§ 5103A, 5107, 5110; 38 C.F.R. §§ 3.157(b); 3.400.
7. The criteria for an effective date of April 25, 2016, for the assignment of a separate 10 percent disability rating for service-connected right lower extremity radiculopathy have been met.  38 U.S.C. §§ 5103A, 5107, 5110; 38 C.F.R. §§ 3.157(b); 3.400.
8. The appeal for an effective date prior to January 20, 2000, for the award of a 40 percent evaluation for service-connected lumbar myositis is dismissed.  38 U.S.C. §§ 5103A, 5107, 5110; 38 C.F.R. § 3.400; Rudd v. Nicholson, 20 Vet. App. 296 (2006).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran had active service from April 1982 to December 1992.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA), Regional Office (RO).
Increased Rating Claims
Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder.  38 U.S.C. § 1155.  Separate diagnostic codes identify the various disabilities.  It is necessary to rate the disability from the point of view of the Veteran working or seeking work, 38 C.F.R. § 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran's favor.  38 C.F.R. § 4.3.  If there is a question as to which disability rating to apply to the Veteran's disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.
In considering the severity of a disability, it is essential to trace the medical history of the Veteran.  38 C.F.R. §§ 4.1, 4.2, 4.41.  Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present.  38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).  While the Veteran's entire history is reviewed when assigning a disability rating, 38 C.F.R. § 4.1, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  Francisco v. Brown, 7 Vet. App. 55 (1994).  However, where the Veteran is appealing the initial assignment of a disability rating, the severity of the disability is to be considered during the entire period from the initial assignment of the disability rating to the present time.  Fenderson v. West, 12 Vet. App. 119 (1999).  Additionally, in determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings.  See Hart v. Mansfield, 21 Vet. App. 505 (2007).  In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary.
It is possible for a Veteran to have separate and distinct manifestations from the same injury that would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition.  See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); 38 C.F.R. § 4.14.
Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance.  It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements.  The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion.  Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled.  38 C.F.R. §§ 4.10, 4.40, 4.45.  VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use.  DeLuca v. Brown, 8 Vet. App. 202 (1995).
Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded.  See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991).  Pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement that affects stability, standing, and weight-bearing.  Therefore, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors.  Consideration must include joint testing for pain on both active and passive motion, in weight bearing and non-weight bearing and, if possible, with range of motion measurements of the opposite undamaged joint.  Correia v. McDonald, 28 Vet. App. 158 (2016).
The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups.  The guidance provided under DeLuca must be followed in adjudicating claims where a rating under the diagnostic code provisions governing limitation of motion should be considered.  However, the provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45, will only be considered in 
conjunction with diagnostic code provisions predicated on limitation of motion.  Johnson v. Brown, 9 Vet. App. 7 (1996).  The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability.  It is the intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.  38 C.F.R. § 4.59.
Lumbar Spine Disability
The Veteran asserts that his service-connected low back disability is more disabling than reflected by the currently assigned 40 percent disability rating.  The Board notes that during the pendency of this appeal, the Veteran underwent low back surgery, after which a temporary total (100 percent) disability rating was assigned from May 23, 2016 to November 30, 2016, and from February 6, 2016 to June 30, 2017.  This decision will address the level of disability for the periods since the date of claim during which a total disability rating was not assigned.
The Veteran’s low back disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5021-5243.  Hyphenated Diagnostic Codes are used when a rating under one diagnostic code requires the use of an additional one to identify the basis for the rating assigned; the additional diagnostic code is shown after the hyphen.  38 C.F.R. § 4.27. 
Diagnostic Code 5021 provides the rating criteria for myositis.  Disabilities rated under Diagnostic Code 5021 are to be rated on limitation of motion of the affected part which, in this case, is the thoracolumbar spine.  Limitation of motion of the thoracolumbar spine is rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula).  The criteria of the General Rating Formula are applied with and 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.  Associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are rated separately under an appropriate diagnostic code.  38 C.F.R. § 4.71a, General Rating Formula, Note (1). 
The General Rating Formula pertinent to the thoracolumbar spine provides that a 40 percent disability rating is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less; if there is favorable ankylosis of the entire thoracolumbar spine; or, if there is unfavorable ankylosis of the entire cervical spine.  A 50 percent disability rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine.  A 100 percent disability rating is warranted if there is unfavorable ankylosis of the entire spine.
Ankylosis is immobility and consolidation of a joint due to disease, injury, surgical procedure.  Lewis v. Derwinski, 3 Vet. App. 259 (1992) (memorandum decision); Nix v. Brown, 4 Vet. App. 462, 465 (1993); and Shipwash v. Brown, 8 Vet. App. 218, 221 (1995).  Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint.  Dinsay v. Brown, 9 Vet. App. 79, 81 (1996).
For VA compensation purposes, normal forward flexion of the thoracolumbar spine is from zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion is zero to 30 degrees, and left and right later rotation is zero to 30 degrees.  The normal combined range of motion of the thoracolumbar spine is 240 degrees.  General Rating Formula, Note (2). 
Diagnostic Code 5243 provides that intervertebral disc syndrome is to be rated at 40 percent where there is evidence of incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the preceding 12 months.  A 60 percent disability rating requires evidence of incapacitating episodes having a total duration of at least six weeks during the preceding 12 months.  For purposes of rating under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.  Id. at Note 1.
A review of the Veteran’s claims file reveals that following the issuance of a May 2009 rating decision, there is no evidence received within one year which relates to the service-connected low back disability.  Thus, with respect to the Veteran's claim seeking an increased disability rating, the December 2017 rating action is the proper rating decision on appeal.  See Buie v. Shinseki, 24 Vet. App. 242, 251-252 (2010), see also Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011).  
Private medical record from Y.C. Rivera Colon, M.D., received in July 2016, shows that the Veteran was said to have undergone anterior lumbar fusion surgery in May 2016.
A VA examination report dated in September 2016 shows that the Veteran was diagnosed with lumbosacral strain, intervertebral disc syndrome, lumbar disc herniation, and lumbar myositis.  A history of lumbar fusion in 2016 was indicated.  The Veteran reported daily flare-ups lasting hours.  Repetitive use was said to result in loss of standing and ambulation tolerance.  Range of motion was abnormal with forward flexion limited to 15 degrees.  There was evidence of pain on weight-bearing.  There was evidence of lumbar paravertebral localized tenderness or pain on palpation.  Repetitive use testing was said to potentially result in pain, weakness, fatigability or incoordination that could significant limit functional ability, however, it could not be established without mere speculation.  Guarding, muscle spasm, and localized tenderness did not result in abnormal gait or abnormal spinal contour.  Muscle strength was within normal limits.  There was no muscle atrophy.  Reflex and sensory examinations were within normal limits.  There was mild paresthesia and numbness of each lower extremity (separately rated).  There was no ankylosis of the spine.  There were no other neurological manifestations.  The Veteran did not have intervertebral disc syndrome of the thoracolumbar spine.  The constant use of a cane for assistance was indicated.  There were surgical scars (separately rated).  The back disability was said not to impact the Veteran’s ability to work.
Private medical record from the Puerto Rico Spine Center dated in March 2017 shows that the Veteran underwent an oblique lumbar interbody fusion procedure in February 2017. 
A VA examination report dated in June 2017 shows that the Veteran was diagnosed with lumbar paravertebral myositis with herniated nucleus pulposus and degenerative arthritis.  A history of the February 2017 surgery was noted, and the Veteran stated that he had experienced no improvement.  He described symptoms of lumbar pain that would worsen with prolonged ambulation, standing, and sitting.  The Veteran reported flare-ups with prolonged ambulation, standing, and sitting activities.  He described difficulty with dressing the lower extremities, specifically with lacing his shoes.  Range of motion was abnormal with forward flexion limited to 10 degrees.  There was evidence of mild lumbar paravertebral localized tenderness on palpation.  There was no additional loss of motion following repetitive use.  Repetitive use was said to potentially result in pain, weakness, fatigability or incoordination that could significant limit functional ability, however, it could not be established without mere speculation.  Guarding and muscle spasm did not result in abnormal gait or abnormal spinal contour.  Muscle strength was within normal limits.  There was no muscle atrophy.  Reflex and sensory examinations were within normal limits.  There was no radiculopathy.  There was no ankylosis of the spine.  There were no other neurological manifestations.  The Veteran did not have intervertebral disc syndrome of the thoracolumbar spine.  He did not use any assistive devices for ambulation.  There were surgical scars (separately rated).  There was no pain on passive range of motion or on weight-bearing.  The back disability was said not to impact the Veteran’s ability to work.
A VA examination report dated in December 2017 shows that the Veteran was diagnosed with lumbar paravertebral myositis with herniated nucleus pulposus, degenerative arthritis, and lumbar strain.  The Veteran reported continued constant back pain that fluctuated in intensity (stronger in the mornings when getting up from bed and in the evenings after a day at work) with stiffness of his back.  He described difficulty standing from the sitting position and with bending forward. His back pain would ache with pressure and would increases in intensity with prolonged sitting, standing, walking, or bending.  He would experience difficulty with lower himself onto the toilet and with putting on his socks and shoes.  He indicated that he had two different back surgeries, and that he used to have strong pain that radiated down his legs (sciatica), but that this pain was not present anymore after the surgery.  He would frequently feel heaviness and occasional tingling in his legs with cramping of the leg muscles.  The Veteran reported flare-ups with prolonged ambulation, standing, sitting, and bending.  Functional loss was described as decreased endurance to standing, walking, and sitting in the same position.  
Range of motion was abnormal with forward flexion limited to 25 degrees.  Pain would cause additional functional loss.  There was no evidence of pain on weight-bearing.  There was evidence of tenderness to palpation of the lumbar paravertebral muscles and at midline of the sacrum.  There was pain and lack of endurance following repetitive use.  Repetitive use was said to potentially result in pain, weakness, fatigability or incoordination that could significant limit functional ability, however, it could not be established without mere speculation.  Guarding and muscle spasm did not result in abnormal gait or abnormal spinal contour.  Muscle strength was within normal limits or active movement against some resistance.  There was no muscle atrophy.  Reflex and sensory examinations were within normal limits.  There was moderate intermittent pain; mild paresthesias and/or dysesthesias; and mild sciatic radiculopathy of the bilateral lower extremities (rated separately).  There was no ankylosis of the spine.  There were no other neurological manifestations.  The Veteran had intervertebral disc syndrome of the thoracolumbar spine with incapacitating episodes of two to four weeks in the preceding 12 months.  He did not use any assistive devices for ambulation.  There were surgical scars (separately rated).  There was no pain on passive range of motion or on weight-bearing.  The back disability was said limit the Veteran in lifting, pushing, pulling, or carrying objects.  He could not carry objects that weigh 10 or more pounds, and could not do activities that required rapid trunk movement, repetitively going from sitting to standing and vice versa.  He was limited to sedentary type activities and should not participate in high impact activities.
After careful review of the evidence of record, the Board finds no basis for the assignment of an increased disability rating.  In this regard, intervertebral disc syndrome has not been shown at any time during the period on appeal to exceed four weeks in the preceding 12-month period.  Thoracolumbar forward flexion ranged between 10 and 25 degrees.  At no time was the thoracolumbar or entire spine ankylosed.
While there was lower extremity radiculopathy, that will be addressed further below, the medical evidence of record also did not show any bowel or bladder diagnosis related to the low back disability.  See 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note (1).  There are no other neurological changes related to the service-connected low back disability that would warrant an additional separate disability rating.
The Board has also considered the provisions of 38 C.F.R. § 4.40, 4.45, 4.59, and the holdings in DeLuca and Mitchell.  In Johnston v. Brown, 10 Vet. App. 80, 85 (1997), the United States Court of Appeals for Veterans Claims (Court) indicated that where the Veteran is in receipt of the maximum schedular disability rating based on limitation of motion and a higher rating requires ankylosis, the cited regulations are not for application.  See Id. at 84-85 (although the Secretary suggested remand because of the Board’s failure to consider functional loss due to pain, remand was not appropriate because higher schedular rating required ankylosis).  As the Veteran is receiving the maximum schedular rating for his back disability based on limitation of motion, and a higher rating requires ankylosis, consideration of flare-ups, or the adequacy of the orthopedic exams, is not required.
The Board also acknowledges assertions made by the Veteran, but these statements do not indicate any symptoms warranting a higher disability rating or symptoms not contemplated by the applicable diagnostic code and the general rating formula for diseases and injuries of the spine.  The general rating formula for diseases and injuries of the spine indicates that its criteria apply 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.  This broad language in the criteria thus contemplates all of the symptoms even though they are not specifically listed.  See also Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (holding that § 4.59 applies to “joint pain in general” and is not limited to joint pain due to arthritis);
Where, as here, the preponderance of the evidence is against the claim, the benefit of the doubt rule is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3.
Bilateral Lower Extremity Radiculopathy
The Veteran asserts that his service-connected radiculopathy of the left and right lower extremities is more disabling than reflected by the currently assigned, respective, 10 percent disability rating.  Each lower extremity has been rated under Diagnostic Code 8520 which provides the criteria for paralysis of the sciatic nerve.
Under Diagnostic Code 8520, disability ratings of 10 percent, 20 percent, and 40 percent are assignable for incomplete sciatic nerve paralysis that is mild, moderate, or moderately severe in degree, respectively.  A 60 percent disability rating is warranted for severe incomplete paralysis with marked muscle atrophy.  The maximum 80 percent disability rating is warranted when there is complete paralysis of the sciatic nerve, which contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost.  38 C.F.R. 4.124a, Diagnostic Code 8520.
A review of the Veteran’s claims file reveals that by rating action dated in December 2017, separate service connection for radiculopathy of the lower extremities was granted, with each extremity assigned a 10 percent disability rating.
A VA peripheral nerves examination report dated in July 2016 shows that the Veteran reported severe radicular symptoms at the right lower extremity and then at the left lower extremity.  He described lumbar pain with numbness at the thigh area.  He added that following the May 2016 surgery, he had no active radicular symptoms.  He also reported moderate numbness of each lower extremity.  Muscle strength, reflex, and sensory testing were within normal limits.  All nerves of the lower extremities, to include the sciatic nerve, were said to be normal.  A September 2008 electromyographic study was referenced which was said to be normal.  The peripheral nerve condition was said not to impact the Veteran’s ability to work.
The September 2016 VA examination report shows that there was mild paresthesia and numbness of each lower extremity.  The June 2017 VA examination report shows that there was no radiculopathy.
The December 2017 VA examination report shows that the Veteran reported that he no longer experienced pain radiating into the lower extremities.  The examiner described moderate intermittent pain; mild paresthesias and/or dysesthesias; and mild sciatic radiculopathy of the bilateral lower extremities.
With respect to each lower extremity, the preponderance of the evidence of record shows objective neurological symptoms that support a disability rating analogous to mild incomplete paralysis of the sciatic nerve such that the currently assigned 10 percent disability rating for each lower extremity is most closely approximated.
The Board finds that the criteria for the next higher 20 percent disability rating under Diagnostic Code 8520 are not met.  While the Veteran described moderate pain on examination in July 2016 and December 2017, the VA examiner in each instance described the peripheral neuropathy as mild.  The Veteran, himself, has repeatedly indicated that he has not experienced radiculopathy following his two surgeries.  There has been no atrophy of the lower extremities.  Although an examiners characterization of the evidence is not binding on the Board, here the characterizations of the levels of the radiculopathy as mild are consistent with the evidence.  
The Board also acknowledges assertions made by the Veteran, but they do not reflect symptoms that more nearly approximate the moderate incomplete paralysis required for a higher rating under Diagnostic Code 8520. 
For the foregoing reasons, the preponderance of the evidence is against the claims for higher ratings for radiculopathy of each lower extremity.  The benefit of the doubt rule is not for application.  38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3.
 
Right Ankle Disability
The Veteran asserts that his service-connected right ankle contracture is more disabling than reflected by the currently assigned 10 percent disability rating.  The right ankle disability has been rated under Diagnostic Code 5271 which provides the criteria for limitation of motion of the ankle.
Pursuant to Diagnostic Code 5271, a 10 percent disability rating is warranted when there is moderate limitation of motion.  The maximum 20 percent disability rating is assigned where the limitation of motion is marked.  Normal range of ankle motion is identified as dorsiflexion of zero to 20 degrees and plantar flexion of zero to 45 degrees.  See 38 C.F.R. § 4.71, Plate II.
Following the issuance of an August 1995 rating decision that granted service connection, assigning an initial 10 percent disability rating, there is no evidence received within one year which relates to the service-connected right ankle disability.  Thus, with respect to the Veteran’s claim seeking an increased disability rating, the December 2017 rating action is the proper rating decision on appeal.  See Buie, 24 Vet. App. at 251-252; Bond, 659 F.3d at 1362.
A VA examination report dated in September 2017 shows that the Veteran was diagnosed with right ankle contracture.  He described discomfort of the right ankle that was intermittent and produced a pressure sensation with prolonged movement.  There was also discomfort with the use of casual shoes.  Symptoms would be relieved with over-the-counter non-steroidal anti-inflammatory drugs.  There were no reported flare-ups of the ankle.  Range of motion was 10 degrees of dorsiflexion and 30 degrees of plantar flexion.  There was no evidence of pain, tenderness, or crepitus on examination.  There was no evidence of pain on weight-bearing.  There was no additional loss of function or range of motion following repetitive use testing.  Muscle strength testing was within normal limits, there was no muscle atrophy, and there was no ankylosis.  There was no joint instability.  There was no use of assistive devices for ambulation.  There was no occupational impairment.
Having carefully considered the evidence of record, the Board finds that the preponderance of that evidence shows objective symptoms support a disability rating analogous to no more than moderate limitation of motion of the right ankle such that the currently assigned 10 percent disability rating is most closely approximated.
It does not appear from the evidence of record that the right ankle disability has had a marked effect on the Veteran’s ability to conduct his daily activities, as well as perform his occupational duties.  Indeed, the VA examiner noted that the Veteran walked with a normal gait, and without the use of any assistive device specifically due to the ankle condition.  The Board acknowledges that the Veteran’s range of motion in the right ankle revealed a 10-degree loss of dorsiflexion and a 15-degree loss of plantar flexion.  While this is reflective of limited motion, it is not shown to be characteristic of marked limitation of motion that is required for the assignment of the next higher disability rating.  Other than reported intermittent pain and moderate limitation of motion, the record does not provide any additional information or discussion as to how these symptoms have affected the Veteran’s daily life or limited his activities.  Indeed, the limited movement does not appear to have had a significant effect on his ability to perform occupational duties. 
While the Board has considered whether a higher rating would be warranted under other relevant diagnostic codes, such as that governing ankylosis of the ankle, ankylosis of the subastragalar joint, malunion of the os calcis or astragalus, and astragalectomy, the Board finds that the criteria for an increased disability rating are simply not met.  See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5272, 5273, 5274 (2009).  In this regard, the Veteran has not been shown to have ankylosis of the left ankle. 
The Board has also considered, along with the scheduler criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness.  38 C.F.R. 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-7 (1995). However, a higher disability rating of the Veteran’s right ankle disability is not warranted on the basis of functional loss due to pain in this case, as the VA examination established that there was no additional loss of function following repetitive use and no flare-ups.  Therefore, a higher disability rating is not warranted as the Veteran’s symptoms are contemplated by the 10 percent disability rating already assigned. 
The Board also acknowledges assertions made by the Veteran, but they do not reflect symptoms that more nearly approximate the marked limitation of motion that is required for a higher rating under Diagnostic Code 5271. 
For the foregoing reasons, the preponderance of the evidence is against the claim for a higher disability rating for the right ankle contracture.  The benefit of the doubt rule is not for application.  38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3.
Right Foot Plantar Callus Disability
The Veteran asserts that his service-connected right foot plantar callus is more disabling than reflected by the currently assigned noncompensable disability rating.  Skin and nail disabilities are rated under 38 C.F.R. § 4.118.  The right foot plantar callus has been rated by analogy under Diagnostic Code 7806 which provides the criteria for dermatitis or eczema.
The Board finds that the utilization of Diagnostic Code 7806 is appropriate for the rating of the Veteran’s service-connected plantar callus.  This diagnostic code most accurately describes his symptoms while providing the Veteran with the highest possible rating.  Under Diagnostic Code 7806, when the disorder covers less than five percent of the entire body or exposed areas affected, and requiring no more than topical therapy during the past 12-month period a noncompensable disability rating is warranted.  A 10 percent disability rating is warranted for involvement of at least five percent, but less than 20 percent, of the entire body, or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. 
A 30 percent rating is assigned for dermatitis or eczema affecting 20 to 40 percent of the entire body or affecting 20 to 40 percent of exposed areas, or; requiring systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past 12-month period. 
A maximum 60 percent rating is assigned for dermatitis or eczema affecting more than 40 percent of the entire body or more than 40 percent of exposed, or; if constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs have been required during the past 12-month period. 
Following the issuance of an August 1995 rating decision that granted service connection, assigning an initial noncompensable disability rating, there is no evidence received within one year which relates to the service-connected right plantar callus.  Thus, with respect to the Veteran’s claim seeking an increased disability rating, the January 2018 rating action is the proper rating decision on appeal.  See Buie, 24 Vet. App. at 251-252; Bond, 659 F.3d at 1362.
A December 2017 VA skin diseases examination report shows that the Veteran was diagnosed with right foot plantar callus.  He reported that his symptoms were better with the use of tennis shoes.  He would use a pommes stone regularly to maintain the skin soft.  The skin condition did not cause scarring or disfigurement of the head, face, or neck.  There was no benign or malignant skin neoplasm.  There were no systemic manifestations.  There was no treatment with or without oral or topical medications over the preceding 12 months.  There were no debilitating or non-debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis in the preceding 12 months.  There were no visible skin conditions and no tumors or neoplasms.  There was a right foot plantar callus on the plantar aspect of the right foot with soft skin seen and no erythema.  There was no functional impact on the Veteran’s ability to work.  
Having carefully considered the preponderance of the evidence, the Board finds that the assignment of a compensable disability rating is not warranted.  In this regard, examination of the Veteran did not reveal any lesions on the skin and no scarring, and the condition did not affect his ability to work and was not disfiguring.  The right foot plantar callus was manifested by soft skin with no erythema.  As such, the disability covered less than five percent of the entire body or exposed areas affected, and required no use of any medical therapy during the preceding 12-month period warranting a noncompensable disability rating.  See 38 C.F.R. § 4.118, Diagnostic Code 7815.
The Board also acknowledges assertions made by the Veteran, but they do not reflect symptoms that more nearly approximate the criteria for the next higher disability rating under Diagnostic Code 7806.  
For the foregoing reasons, the preponderance of the evidence is against the claim for a higher disability rating for the right plantar callus.  The benefit of the doubt rule is not for application.  38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3.
Effective Date Claims
Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 
A specific claim in the form prescribed by VA must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 C.F.R. § 3.151(a).  The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief of entitlement, to a benefit.  38 C.F.R. § 3.1(p).  “Date of receipt” generally means the date on which a claim, information or evidence was received by VA.  38 C.F.R. § 3.1(r).
The applicable statutory and regulatory provisions require that VA look to all communications from the appellant which may be interpreted as applications or claims - formal and informal - for benefits.  VA is required to identify and act on informal claims for benefits.  38 U.S.C. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a).  Informal claims must identify the benefit sought.  38 C.F.R. § 3.155(a).
In cases involving increases in disability compensation, the effective date will be the earliest date at which it is factually ascertainable that an increase in disability had occurred if the claim is received within one year from such date.  Otherwise, the date of receipt of the claim will be the effective date.  38 C.F.R. § 3.400(o)(2). 
The date of outpatient or hospital examination will be accepted as the date of receipt of a claim for increased benefits when such reports relate to an examination or treatment of a disability for which service connection was previously established.  38 C.F.R. § 3.157(b); see Harper v. Brown, 10 Vet. App. 125, 126 (1997); but see Hazan v. Gober, 10 Vet. App. 511, 518 (1997). 
Under 38 C.F.R. § 3.157(b)(1), once a formal claim for compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability was not compensable in degree, receipt of outpatient, hospital examination, or admission to a VA or uniformed services hospital will be accepted as receipt of an informal claim for an increased evaluation based on the date of the outpatient treatment, hospital examination, or admission to a VA or uniformed services hospital. 
Awards of Service Connection for Bilateral Lower Extremity Radiculopathy
In March 2005, the Veteran filed a claim for service connection for sciatic neuropathy as secondary to his service-connected low back disability.  Service connection was denied by rating actions in November 2008 and May 2009.  There is no evidence received within one year which relates to the asserted lower extremity radiculopathy.
On April 25, 2016, the RO received the Veteran’s renewed claim of service connection for lower extremity radiculopathy.
VA outpatient treatment records dated in January and June 2016 showed treatment for reported sciatic radiculopathy to the lower extremities.  
The July 2016 VA peripheral nerves examination report showed that the Veteran reported severe radicular symptoms at the right lower extremity and then at the left lower extremity, with pain and numbness.  All nerves of the lower extremities, to include the sciatic nerve, were said to be normal.  
The September 2016 VA examination report showed that there was mild paresthesia and numbness of each lower extremity.  
By rating action dated in September 2016, the RO denied service connection for the sciatic neuropathy, concluding that there was no current diagnosed disability.
In July and August 2017, the Veteran again requested service connection for the sciatic neuropathy.  By rating action dated in December 2017, the RO granted service connection for left and right lower extremity radiculopathy, effective as of July 2, 2017, the date of the Veteran’s claim.
Having reviewed the evidence of record, the Board concludes that the effective date of the assignment of the separate ratings for the left and right lower extremity radiculopathy should be April 25, 2016, the date of the Veteran’s claim.  In this regard, while the claim was denied in the September 2016 rating decision, the Veteran’s subsequent July 2017 claim was within one year of the September 2016 decision.  Therefore, the September 2016 decision had not yet become final.   
Entitlement to an effective date prior to April 25, 2016, however, is not warranted as no evidence had been received within one year of the May 2009 rating decision that relates to the lower extremity radiculopathy.  The Veteran did not appeal this decision; thus, it became final.  38 U.S.C. § 7105(c). 
The Board acknowledges the Veteran’s contention that he had been experiencing neurological symptoms in each lower extremity earlier than his April 2016 claim.  However, under applicable law VA would not be able to assign an effective date prior to that date of claim since he had not filed a claim for an increase, either formal or informal, prior to that time, following the final May 2009 RO decision.  See generally Harper v. Brown, 10 Vet. App. 125 (1997).  
The only way the Veteran could attempt to overcome the finality of the May 2009 decision in an attempt to gain an earlier effective date, is to request a revision of that decision based on clear and unmistakable error (CUE) or by a claim to reopen based on new and material evidence.  See Cook v. Principi, 318 F.3d 1334, 1339 (Fed. Cir. 2002) (en banc); see also 38 U.S.C. § 5109A (a) (“a decision by the Secretary... is subject to revision on the grounds of clear and unmistakable error.  If evidence establishes the error, the prior decision shall be reversed or revised.”); 38 U.S.C. § 5108 (“if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim.”); Andrews v. Nicholson, 421 F.3d 1278, 1281 (Fed. Cir. 2005).  The Veteran has done neither. 
Since the July 2005 RO decision is final, the decision is not subject to revision in the absence of CUE in the decision.  38 U.S.C. §§ 7105, 5109A; see Rudd v. Nicholson, 20 Vet. App. 296 (2006) (finding that only a request for revision based on CUE could result in the assignment of an effective date earlier than the date of a final decision).  CUE in any of the prior RO decisions has not been alleged.  
In the present case, Board finds that the effective date for the assignment of separate 10 percent respective disability rating for left and right lower extremity radiculopathy is April 25, 2016, but no earlier.
Award of a 40 percent Evaluation for the Lumbar Spine Disability.
In Rudd, 20 Vet. App. at 299-300, the Court held that once a rating decision which establishes an effective date becomes final, the only way that such a decision can be revised is if it contains CUE.  The Court noted that any other result would vitiate the rule of finality.  In other words, the Court has found that there are no freestanding claims for an earlier effective date.  When such a freestanding claim for an earlier effective date is raised, the Court has held that such an appeal should be dismissed. 
Here, the Veteran maintains that the grant of entitlement to a 40 percent disability rating for the service-connected low back disability should be made effective earlier than January 20, 2000.
By way of history, in a February 1994 rating decision, the RO awarded entitlement to service connection, wherein a 20 percent disability rating was assigned effective as of December 19, 1992.  In February 2000, the Veteran indicated that he wished to file for an increased disability rating.  By rating action dated in June 2000, the disability rating was increased to 40 percent, effective as of January 20, 2000.  The Veteran, thereafter, had one year to file a notice of disagreement as to the effective date assigned.  38 U.S.C. § 5107; 38 C.F.R. § 20.302.  He did not do so.
In July 2016, the Veteran filed a claim for an increased disability rating.  In December 2017, this claim was denied.  In his February 2018 notice of disagreement, the Veteran, in pertinent part, disagreed with the effective date assigned for his 40 percent disability rating.  
The first suggestion following the June 2000 rating decision of any disagreement with the effective date was his February 2018 notice of disagreement.  This document, however, was submitted after the time period for perfecting an appeal of the June 2000 rating decision.  Thus, the February 2018 statement cannot serve as a valid notice of disagreement as to that issue. 
The Board notes that the RO developed this matter on its merits; however, the Court in Rudd held that there was no “freestanding” earlier effective date claim that could be raised at any time after a RO decision became final.  See Rudd, 20 Vet. App. at 300.  The Court further indicated that because “there is no proper claim in this case,” the matter was dismissed.  
In conclusion, to the extent that the Veteran attempted to raise a freestanding earlier effective date claim in his February 2018 notice of disagreement, and based on the procedural history of this case, particularly in light of Rudd, the Board has no alternative but to dismiss the appeal as to this issue.  See VAOPGCPREC 9-99 (indicating that the Board may dismiss any appeal which is not timely filed). 
The only way the Veteran could attempt to overcome the finality of the June 2000 decision in an attempt to gain an earlier effective date, is to request a revision of that decision based on CUE or by a claim to reopen based on new and material evidence.  See Cook, 318 F.3d at 1339; Andrews, 421 F.3d at 1281; see also 38 U.S.C. §§ 5108, 5109A(a).  The Veteran has done neither. 
Since the June 2000 RO decision is final, the decision is not subject to revision in the absence of CUE in the decision.  38 U.S.C. §§ 7105, 5109A; see also Rudd. CUE in any of the prior RO decision has not been alleged.  There is no legal basis for making the effective date of the assigment of a 40 percent disability rating for the service-connected low back disability prior to the currently assigned January 20, 2000.
REASONS FOR REMAND
1.  Entitlement to service connection for left and right hip disorders.
The Veteran asserts that he has left and right hip disorders that are manifested as a result of his period of active service.  While his service treatment records are negative for any related diagnoses, a May 2017 private medical record from C. E. Mora Quesada, M.D., suggests that his musculoskeletal diseases, to include involving the hips, are more probable than not secondary to active service.  This opinion, however, does not include a rationale for the conclusion reached.  The Board cannot make a fully-informed decision on the issue because no VA examiner has opined on it.  As such, a remand is required prior to further adjudication.
2.  Entitlement to service connection for left and right knee disorders.
The Veteran asserts that he has left and right knee disorders that are manifested as a result of his period of active service.  While his service treatment records are negative for any left knee diagnosis, there is a service treatment record dated in September 1985 that shows treatment for a one-week history of right knee pain with a diagnosis of chondromalacia.  Following service, a VA examination report dated in November 2017 shows a diagnosis of left and right knee strain.  However, in addressing the requested nexus opinion, the examiner concluded that the examination was then unremarkable for any conditions.  The Board finds the findings of the VA examiner to be inconsistent in that there is a diagnosis of a strain and an opinion of an unremarkable evaluation.  Additionally, the May 2017 private medical record from Dr. Mora Quesada, suggests that the musculoskeletal diseases, to include the knees, are more probable than not secondary to active service.  As this opinion does not include a rationale for the conclusion reached, and as the November 2017 VA examination report is deemed inadequate, the Board cannot make a fully-informed decision on the issue, and a remand is required prior to further adjudication.
3.  Entitlement to service connection for a cervical spine disorder.
The Veteran asserts that he has a cervical spine disorder that is manifested as a result of his period of active service.  A service treatment record dated in March 1984 shows treatment for back pain and tenderness in the generalized area of the left shoulder blade.  He described having recently used a jack and that the pain was greater on the left than the right sides.  The assessment was pulled muscle.  Following service, a VA outpatient treatment record dated in February 2002 shows treatment for persistent left pectoralis pain and painful rotation of the neck.  A VA outpatient treatment record dated in May 2011 shows treatment for a cervical muscle spasm.  The May 2017 private medical record from Dr. Mora Quesada, suggests that the musculoskeletal diseases are more probable than not secondary to active service, though, the opinion does not specifically address the cervical spine.  The Board cannot make a fully-informed decision on the issue because no VA examiner has opined on it.  As such, a remand is required prior to further adjudication.
4. Entitlement to service connection for a left foot disorder.
The Veteran asserts that he has a left foot disorder that is manifested as a result of his period of active service, to specifically include wearing military shoes in service.  A service treatment record dated in June 1992 shows treatment for foot blisters following a road march.  Physical examination revealed blood blisters on the right foot, blisters on the left foot.  The assessment was blisters.  While service connection has been established for right foot plantar callus, he has not been evaluated to determine whether the Veteran has a current left foot disorder related to the in-service treatment for left foot blisters.  The Board cannot make a fully-informed decision on the issue because no VA examiner has opined on it.  As such, a remand is required prior to further adjudication.
5.  Entitlement to service connection for a psychiatric disorder, to include anxiety, depression, and PTSD.
The Veteran asserts that he has an acquired psychiatric disorder that is manifested as a result of his period of active service.  In correspondence received in November 2017, he contends that his asserted psychiatric disorder is related to physical injuries sustained during active service.  The May 2017 private medical record from Dr. Mora Quesada, suggests that the Veteran has diagnoses including generalized anxiety disorder, major depressive disorder, and PTSD that are more probable than not secondary to active service.  This opinion, however, does not include a rationale for the conclusion reached.  The Board cannot make a fully-informed decision on the issue because no VA examiner has opined on it.  As such, a remand is required prior to further adjudication.
The matters are REMANDED for the following action:
1. Ensure that the Veteran is scheduled for a VA examination in order to determine whether his bilateral hip disorders are related to service or secondary to his service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities.  The claims folder must be made available to and be reviewed by the examiner.  All tests deemed necessary should be conducted and the results reported in detail.  
Following examination of the Veteran and review of the claims file, the examiner must opine whether any bilateral hip disorders found at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service.  The examiner should specifically address the May 2017 opinion from Dr. Mora Quesada in providing the requested opinion.
Next, if the examiner does not find that the Veteran’s bilateral hip disorders are directly related to military service, the examiner must opine whether those disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities, to include any abnormal gait or weightbearing as a result of those disabilities.  The examiner is reminded that he or she must address both prongs (a) and (b) above.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
2. Ensure that the Veteran is scheduled for a VA examination in order to determine whether his bilateral knee disorders are related to service or secondary to his service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities.  The claims folder must be made available to and be reviewed by the examiner.  All tests deemed necessary should be conducted and the results reported in detail.  
Following examination of the Veteran and review of the claims file, the examiner must opine whether any bilateral knee disorders found at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service, to include the September 1985 treatment for chondromalacia of the right knee.  The examiner should specifically address the May 2017 opinion from Dr. Mora Quesada in providing the requested opinion.
Next, if the examiner does not find that the Veteran’s bilateral knee disorders are directly related to military service, the examiner must opine whether those disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities, to include any abnormal gait or weightbearing as a result of those disabilities.  The examiner is reminded that he or she must address both prongs (a) and (b) above.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
3. Ensure that the Veteran is scheduled for a VA examination in order to determine whether his cervical spine disorder is related to service or secondary to his service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities.  The claims folder must be made available to and be reviewed by the examiner.  All tests deemed necessary should be conducted and the results reported in detail.  
Following examination of the Veteran and review of the claims file, the examiner must opine whether any cervical spine disorder found at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service, to include the March 1984 treatment for back pain and tenderness in the generalized area of the left shoulder blade.  The examiner should specifically address the May 2017 opinion from Dr. Mora Quesada in providing the requested opinion.
Next, if the examiner does not find that the Veteran’s cervical spine disorder are directly related to military service, the examiner must opine whether those disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine with associated bilateral lower extremity radiculopathy disabilities, to include any abnormal gait or weightbearing as a result of those disabilities.  The examiner is reminded that he or she must address both prongs (a) and (b) above.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
4. Ensure that the Veteran is scheduled for a VA examination in order to determine whether his left foot disorder is related to service.  The claims folder must be made available to and be reviewed by the examiner.  All tests deemed necessary should be conducted and the results reported in detail.  
Following examination of the Veteran and review of the claims file, the examiner must opine whether any left foot disorders found at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service, to include the June 1992 treatment for left foot blisters.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
5. Ensure that the Veteran is scheduled for a VA psychiatric examination in order to determine whether any current psychiatric disorder is related to military service or secondary to his service-connected disabilities.  The claims file must be made available to and be reviewed by the examiner in conjunction with the examination.  
Following review of the claims file and examination of the Veteran, the examiner should identify all DSM-V psychiatric disorders currently suffered by the Veteran, to include any anxiety or depressive disorders, and/or PTSD.  
If PTSD is diagnosed, the examiner should specify the incident or stressor with which that diagnosis is being made and whether such stressor occurred during military service.  
For each non-PTSD psychiatric disorder found, to include anxiety and depressive disorders, the examiner should provide an opinion regarding whether each disorder at least as likely as not (50 percent or greater probability) began in or is otherwise related to military service.  
Next, if the examiner does not find that the Veteran’s psychiatric disorders are directly related to military service, the examiner must opine whether those disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected disabilities.  The examiner is reminded that he or she must address both prongs (a) and (b) above.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
 
MARTIN B. PETERS
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	D. Orfanoudis, Counsel 

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For More Information on Veterans Disability Compensation Benefits! Visit: DisableVeteran.org ~ A Non-Profit Non Governmental Agency


Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.