Citation Nr: 1320470 Decision Date: 06/25/13 Archive Date: 07/05/13 DOCKET NO. 08-14 254 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to a disability rating in excess of 20 percent for chronic back pain with spondylolisthesis L5-S1, status post fusion. 2. Entitlement to a disability rating in excess of 10 percent for left lower extremity radiculopathy prior to July 8, 2009. 3. Entitlement to a separate compensable disability rating for right lower extremity radiculopathy prior to July 8, 2009. 4. Entitlement to a disability rating in excess of 10 percent for painful scars prior to June 10, 2010 and to a disability rating in excess of 20 percent for painful scars from September 17, 2011. 5. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J.M. Seay, Associate Counsel INTRODUCTION The Veteran had Reserves service with a period of inactive duty for training from March 4, 1983 to March 6, 1983. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, which increased the disability rating for chronic back pain with spondylolisthesis L5-S1, status post fusion, to 20 percent, effective February 2, 2006. In a July 2010 decision, the Board denied the Veteran's claim of entitlement to a disability rating in excess of 20 percent for chronic back pain with spondylolisthesis L5-S1, status post fusion, and to a disability rating in excess of 10 percent for left lower extremity radiculopathy prior to July 8, 2009, granted a 20 percent rating for left and right lower extremity radiculopathy, effective July 8, 2009, and granted a 10 percent disability rating for painful scars, effective June 10, 2010. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In February 2011, the Court issued an order granting a February 2011 Joint Motion to Remand (JMR) to partially vacate and remand the issues of entitlement to a disability rating in excess of 20 percent for chronic back pain with spondylolisthesis L5-S1, status post fusion, and entitlement to a separate rating for painful scars prior to June 10, 2010 and entitlement to higher or separate ratings for left and right lower extremity radiculopathy prior to July 8, 2009. The JMR left undisturbed that part of the July 2010 Board decision that had granted a 20 percent for the left and right lower extremity radiculopathy, effective July 8, 2009. The case was returned to the Board for review and the Veteran's claims were remanded in August 2011 and October 2012. In a June 2012 rating decision, the RO granted a disability rating of 20 percent for painful scars, effective September 17, 2011. Therefore, the issue has been characterized as shown on the title page. The case has now been returned to the Board for further review. In June 2010, the Veteran testified before the undersigned during a Travel Board hearing in Montgomery, Alabama. A transcript of the hearing is associated with the claims file. FINDINGS OF FACT 1. Effective February 2, 2005, the Veteran's chronic back pain with spondylolisthesis L5-S1, status post fusion has manifested in complaints of pain, flare-ups, severe functional impairment, and forward flexion, at its worst, to 35 degrees, but has not manifested in ankylosis of the thoracolumbar spine; or, incapacitating episodes requiring physician prescribed bed rest. 2. Effective February 2, 2005, the radiculopathy of the left lower extremity was manifested by moderate incomplete paralysis. 3. Effective February 2, 2005, the radiculopathy of the right lower extremity was manifested by moderate incomplete paralysis. 4. Effective June 10, 2010, the Veteran's five scars have been painful upon objective demonstration. 5. The Veteran is unable to secure or follow a substantially gainful occupation as a result of her service-connected disabilities, effective February 2, 2005. CONCLUSIONS OF LAW 1. Effective February 2, 2005, the criteria for a disability rating of 40 percent, but no higher, for chronic back pain with spondylolisthesis L5-S1, status post fusion have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5241 (2012). 2. Effective February 2, 2005, the criteria for a 20 percent disability rating, but no higher, for left lower extremity radiculopathy have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 8699-8620 (2012). 3. Effective February 2, 2005, a separate disability rating of 20 percent, but no higher, for right lower extremity radiculopathy has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 8699-8620 (2012). 4. Effective June 10, 2010, the criteria for a separate 10 percent disability rating for midline posterior scar has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). 5. Effective June 10, 2010, the criteria for a separate 10 percent disability rating for left hip scar has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). 6. Effective June 10, 2010, the criteria for a separate 10 percent disability rating for right hip scar has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). 7. Effective June 10, 2010, the criteria for a separate 10 percent disability rating for right lateral calf scar has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). 8. Effective June 10, 2010, the criteria for a separate 10 percent disability rating for left of midline scar has been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). 9. Effective February 2, 2005, the criteria for entitlement to a TDIU is met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). The Veteran was apprised of VA's duties to both notify and assist in correspondence dated in February 2006, before the initial adjudication of the claim, and again in October 2007. Correspondence dated in March 2006 included the criteria for assigning disability ratings and for award of an effective date. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The RO also provided a statement of the case (SOC) and supplemental statements of the case (SSOC) reporting the results of its reviews of the issue on appeal and the text of the relevant portions of the VA regulations. Although the complete notice was not provided until after the RO initially adjudicated the Veteran's increased rating claim, the claim were properly re-adjudicated in May 2009, which followed the adequate notice. See Prickett v. Nicholson, 20 Vet. App. 370, 376-77 (2006). With respect to the ratings for left lower extremity radiculopathy, right lower extremity radiculopathy, and scars, that were granted during the pendency of the appeal, the predecisional letter dated in February 2006 satisfied the duty to notify provisions. In addition, the March 2006 letter notified the Veteran regarding the evidence needed to assign a disability rating and effective date. In cases where service connection has been granted, and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Goodwin v. Peake, 22 Vet. App. 128, 136 (2008); Dingess, 19 Vet. App. at 484. Regarding VA's duty to assist, the RO obtained the Veteran's service treatment records (STRs), post-service medical records, and secured examinations in furtherance of her claims. The record also contains the Veteran's updated VA treatment records and Social Security Administration (SSA) records in accordance with the Board's remand. Stegall v. West, 11 Vet. App. 268 (1998). In accordance with the Board's remand, the Veteran was sent notification regarding the issues on appeal, was provided the opportunity to identify or submit clinical records or alternative records, and asked to clarify whether she contends that she is unemployable due to her service-connected disabilities. The Veteran did not respond to the letter. Therefore, the Board finds that the remand directives were completed. Id. VA examinations were obtained in March 2006, July 2009, and March 2013. 38 U.S.C.A. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As noted below, the Board finds that the VA examinations obtained in this case are adequate, as they consider the statements of the Veteran, provide the medical information necessary to apply the appropriate rating criteria, and provide explanations for opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met and that the Board's remand directives were completed. 38 C.F.R. § 3.159(c)(4); Stegall, id. LAW AND ANALYSIS Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (2012). Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2012); see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). The primary concern in a claim for an increased evaluation for service-connected disability is the present level of disability. Although the overall history of the disability is to be considered, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). VA has a duty to consider the possibility of assigning staged ratings in all claims for increase. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran's chronic back pain with spondylolisthesis L5-S1, status post fusion is rated under Diagnostic Code 5241. The general rating formula for diseases and injuries of the spine provides for the disability ratings under Diagnostic Codes 5235 to 5243, unless the disability rated under Code 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, for diseases and injuries of the spine, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Under the general rating formula for diseases and injuries of the spine, ratings related to the thoracolumbar spine are assigned as follows: A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Intervertebral disc syndrome (preoperatively or postoperatively) may be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months warrants a 20 percent rating. A 40 percent rating is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. 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 of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Treatment records show the Veteran's continued complaints of pain and treatment for her back. The Veteran was seen by a private physician in January 2006 complaining of problems with her back. She complained of severe pain and discomfort. She was noted to be lying flat on the examination room floor with her knees bent, complaining of back pain. She had increased back pain with flexion of the left knee. The impression noted her history of multiple back surgeries, and commented that she probably had scar tissue that was hurting. The Veteran was afforded a VA examination in March 2006. She reported undergoing a total of seven surgeries on her back. She walked with a cane, with a flexed, painful gait. Her walk was very slow and guarded, and she made sounds of pain and displayed facial grimaces. She was barely able to get up on the table due to her severe back pain. The Veteran wore a back brace. She was very limited in how far she could walk because she continually had severe back pain 24 hours/7 days per week. She did not require help with activities of daily living such as eating, grooming, bathing, toileting, and dressing. She was unable to participate in any recreational activities and her driving was very limited. She reported that she could not sit long in one place and must constantly move around due to her chronic, severe back pain. The Veteran was noted throughout the examination to get up, constantly to stretch, and move around. The Veteran reported that most of the time she was on bed rest and confined to her home due to her severe back pain. She did not report any incapacitation where she was placed on bed rest by a physician in the last 12 months, but she put herself on bed rest daily due to her severe pain. The Veteran had significant tenderness on palpation of the lumbar spine and could barely stand for the examiner to touch that area. On range of motion testing, she had 40 degrees of flexion with severe pain, facial grimacing and moaning. She was unable to complete the further range of motion of extension, lateral flexion bilaterally, and lateral rotation bilaterally, due to severe pain of the lumbar spine. At that point, the examination was abruptly halted and the examiner was not able to do further testing for her sensory or neurological area. The Veteran was in severe pain at that time. On May 16, 2006, the Veteran presented to her private physician with complaints of a several day history of intensified back pain. She had had seven past laminectomies of the lower lumbar spine and sacroiliac areas, especially on the left. An August 2006 treatment note indicated that she was still having severe pain and discomfort in the lower back, with pain radiating into the left lower limb. The examiner stated that what the Veteran described as knee pain was actually pain radiating down the anterior aspect of her thigh down to the knee; this was noted to be getting progressively worse. She stated that she had difficulty standing or sitting due to her back pain and that lying down was her only relief. This suggested some degree of nerve root compression. On examination, she was markedly tender over the L3-4 and L4-5 areas, with paravertebral muscle spasms. There was no tenderness over the sciatic notch. Certain manipulations of the left knee caused low back pain. A CAT scan did not show nerve root compression but she did have some facet joint arthritis. In August 2008, the Veteran was again seen with continuing complaints of low back pain, which she described as sharp and constant. It was aggravated by movement and relieved by lying down. She denied any numbness. She displayed bilateral sacroiliac joint tenderness. A March 2009 note referred to severe pain in her low back. She was noted to have some degree of give way weakness in the left leg. The assessment was symptomatic lumbar radiculopathy. The Veteran was afforded a VA examination in July 2009. The Veteran had continuing lumbar degeneration with severe osteopenia. Her pain was reported to be constant, rated as eight on a scale of one to ten (8/10) with occasional sharp and stabbing pain rated as 10/10 with certain movement. Since her stroke, the Veteran had muscle cramps that came and went in her back and legs. She used a wheelchair, and could stand briefly without the assistance of her cane, but not for longer than ten minutes without weakness and trembling in the lower extremities. She used a cane when standing. She had a granddaughter that lived with her to assist her with activities of daily living. She had numbness, paresthesias, leg or foot weakness, falls, unsteadiness, fatigue, decreased motion, stiffness, weakness, spasms, and pain. The pain was located in her lumbar back to hips, bilaterally. It was reported to be severe, constant in duration, and daily in frequency. She had radiation to her legs, particularly the left leg. There were no flare-ups of spinal conditions. She was unable to walk more than a few yards with assistive device. Examination of the spine revealed an increase in lumbar lordosis with fixed spasm induced a flexion posture. Gait was not normal; there was halting and shuffling with assistive device. There was no gibbus, lumbar flattening or scoliosis, but there was kyphosis, list, and lumbar lordosis. There were no objective abnormalities of the cervical sacrospinalis, and objective abnormalities of the thoracic sacrospinalis included spasm, atrophy, guarding, pain with motion, tenderness, and weakness, on both the left and right sides. On range of motion, the Veteran had flexion to 35 degrees; extension to 10 degrees, lateral flexion to 10 degrees bilaterally; left lateral rotation to 15 degrees; and right lateral rotation to 10 degrees. There was objective evidence of pain on active range of motion and following repetitive motion. There were no additional limitations after three repetitions of range of motion. Lasegue's sign was positive on both sides. EMG testing revealed left lower radiculopathy, moderate. The Veteran's back disability had a moderate effect on feeding and grooming; a severe effect on chores, traveling, bathing, dressing, and toileting; and prevented shopping, exercise, sports, and recreation. A private treatment note from November 2009 referred to her complaints of being in a significant amount of pain. She was wearing a back brace; the physician discussed with her various ways to strengthen her back musculature. The assessment was lumbar radicular syndrome. The August 2010 VA treatment record noted that the Veteran ambulated with a cane. She reported that she was unable to walk, stand, or sit for prolonged periods without low back pain. She stated that the pain was like something sticking constantly in low back and radiates down the legs to knees. On examination, the spine exhibited full range of motion, with no spinal deformities, and was non-tender. The Veteran was provided a VA examination in September 2011. The Veteran arrived at the examination in a wheelchair and used a cane to walk. The Veteran had an antalgic gait. The Veteran reported a history of seven surgeries. She stated that she had severe burning and stabbing type pain to the bilateral lumbar area that lasts for several hours. She reported that today her pain was a "7" but most of the time the pain level is a "10." She stated that she does not have flare-ups but her pain to the back is severe all the time. She stated that her pain wakes her up at night. She has severe functional impairment secondary to the back in that she is not able to stand more than 10 minutes without the cane and is unable to ambulate without the cane from room to room in the house. If the Veteran does not use the cane, she has to brace on objects for stability. The Veteran is unable to bend over without severe pain, unable to stoop, has difficulty climbing stairs, and is unable to drive for long distances. Forward flexion was 60 degrees, extension was 10 degrees, right lateral flexion was 10 degrees, left lateral flexion was 10 degrees, right lateral rotation was 10 degrees, and left lateral rotation was 10 degrees. With respect to right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation, the objective evidence of painful motion began at 10 degrees. The Veteran was not able to perform repetitive-use testing with three repetitions due to severe pain and poor balance. The examiner indicated that the Veteran had functional loss which included less movement than normal, weakened movement, incoordination, impaired ability to execute skilled movements, and poor balance. The Veteran had tenderness or pain to palpation of the joints and/or soft tissue of the back and had guarding or muscle spasm of the thoracolumbar spine. It was severe enough to result in abnormal gait and abnormal spinal contour. It was noted that the Veteran had intervertebral disc syndrome of the thoracolumbar spine, but had no incapacitating episodes over the past 12 months. The Veteran was provided a VA examination in March 2013. The claims file was reviewed. The diagnosis was listed as lumbar spine spondylolisthesis (s/p 7 spinal surgeries). The Veteran reported flare-ups that impact the function of the thoracolumbar spine. The Veteran stated that her pain is a 9 and continuous and at times, the pain can increase to a 10 several times per day. The Veteran was unable to perform lumbar spine range of motion due to increased pain. With respect to functional loss, the examiner noted that the Veteran's disability manifested in functional loss of less movement than normal, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, interference with sitting, standing, and/or weight-bearing, and the Veteran had a kyphotic posture. When standing to transfer to the examination table, the Veteran was noted to flex at the waist approximately 40 degrees. The Veteran had tenderness to palpation of the lower back. The Veteran's guarding or muscle spasm resulted in an abnormal gait. The Veteran was diagnosed with intervertebral disc syndrome and experienced a total duration of less than 1 week of all incapacitating episodes over the past 12 months. The Veteran used a wheelchair as a normal mode of locomotion. She also used a walker. The examiner indicated that the disability impacted her ability to work. The Veteran reported that she could only stand for a limited period of time and can only walk 15 yards. She had problems performing any tasks within her home. She had problems cooking due to the fact that she cannot stand for extended periods of time. Here, in resolving the benefit of the doubt in favor of the Veteran, the Board finds that the Veteran's disability met the criteria for a disability rating of 40 percent, effective February 2, 2005, a year prior to the date of the Veteran's claim for an increased rating. 38 U.S.C.A. § 5107(b). The effective date of an award of increased compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if the claim is received within one year from such date; otherwise, it is the date of receipt of the claim. 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2); see also Hazan v. Gober, 10 Vet. App. 511 (1997) (requiring VA to consider the evidence of disability during the period one year prior to the application in order to determine when a factually ascertainable increase in disability occurred). The evidence does not reflect that the Veteran's chronic back pain has manifested in flexion of 30 degrees or less or ankylosis. However, the Board has considered functional loss in accordance with VA regulations and DeLuca. 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202 (1995). Here, the July 2009 VA examination report revealed that the Veteran was only able to flex to 35 degrees and the Veteran experienced spasm, atrophy, guarding, pain with motion, tenderness, and weakness, on both the left and right sides. In addition, although the Veteran was able to flex to 60 degrees during the September 2011 VA examination, the examiner specifically noted that the Veteran's spine disability resulted in severe functional impairment in that she was not able to stand more than 10 minutes without the cane and was unable to ambulate without the cane from room to room in the house. The March 2013 VA examination report shows that the Veteran reported that she experiences pain and that her functional loss was less movement than normal, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, interference with sitting, standing and/or weight-bearing. The March 2013 examiner noted that the Veteran had a kyphotic posture and when standing to transfer to the examination table, the Veteran was noted to flex at the waist to approximately 40 degrees. However, it was noted that the Veteran was not able to perform range of motion testing due to increased pain. Based on all of the evidence and resolving the benefit of the doubt in favor of the Veteran, the Board finds that a higher rating of 40 percent is warranted based on the Veteran's functional loss, symptomatology, and limited flexion. However, a disability rating in excess of 40 percent is not warranted. There is no evidence of ankylosis. The medical evidence shows that although the Veteran has not been able to complete range of motion findings due to increased pain, she has been noted to flex her spine, thereby showing that the spine is not ankylosed. The Board has considered whether a higher disability rating could be assigned under Diagnostic Code 5243, intervertebral disc syndrome. The March 2013 VA examination report noted that the Veteran had incapacitating episodes over the past 12 months due to intervertebral disc syndrome. However, the total duration of all incapacitating episodes was less than a week. Therefore, a higher disability rating is not warranted under Diagnostic Code 5243. Thus, while the Board finds that a 40 percent disability rating is warranted, the preponderance of the evidence is against the assignment of a disability rating in excess of 40 percent. Thus, the benefit-of-the-doubt doctrine is not applicable and the claim is denied. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). The Board has also considered referral for extra-schedular consideration. Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). An extraschedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2012). An exceptional case is said to include such factors as marked interference with employment or frequent periods of hospitalization as to render impracticable the application of the regular schedular standards. See Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet App 111 (2008), there is a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the Board must determine whether the claimant's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. With respect to the first prong in Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular rating for the service-connected chronic back pain with spondylolisthesis L5-S1, status post fusion are inadequate. A comparison between the level of severity and symptomatology of the Veteran's symptoms with the established criteria found in the general rating formula for diseases and injuries of the spine reasonably describe ratings for spine disabilities. The evidence does not reflect an exceptional or unusual disability. The Veteran's reported symptoms are encompassed and compensated by her disability rating of 40 percent. Therefore, as the first element is not met, referral to the Director of Compensation and Pension Service pursuant to 38 C.F.R. § 3.321(b)(1) is not warranted. Radiculopathy of the Left Lower Extremity and Radiculopathy of the Right Lower Extremity With respect to the radiculopathy of the left lower extremity, the Veteran was assigned a disability rating of 10 percent from May 8, 2008 and assigned a higher disability rating of 20 percent from July 8, 2009. The issue currently before the Board is whether the Veteran's radiculopathy of the left lower extremity warrants a disability rating prior to May 8, 2008 and whether the Veteran's radiculopathy warrants a disability rating in excess of 10 percent from May 8, 2008 to July 7, 2009. With respect to the radiculopathy of the right lower extremity, in the July 2010 Board decision, the Board granted a separate disability rating for radiculopathy of the right lower extremity and assigned a disability rating of 20 percent, effective July 8, 2009. Thus, the issue is whether the Veteran was entitled to a disability rating prior to July 8, 2009. The radiculopathy of the left lower extremity and right lower extremity have been separately rated under Diagnostic Codes 8699-8620. Each disability is rated by analogy under a Diagnostic Code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27 (2012). The Veteran's radiculopathy has been found to be most analogous to Diagnostic Code 8620, which pertains to neuritis of the sciatic nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8620. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120 (2012). Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123 (2012). Diagnostic Codes 8520, 8620, and 8720 provide the rating criteria for paralysis of the sciatic nerve. Mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. When there is complete paralysis, the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. During the March 2006 VA examination, the examiner was unable to test for radiculopathy due to severe lumbar pain. The August 2006 private treatment record noted that the Veteran complained of pain and discomfort in the lower back with pain radiating to the left lower limb. A private treatment record dated in October 2007 shows that the Veteran reported radicular symptoms in both lower extremities. The assessment was lumbar radiculopathy remained symptomatic. In July 2009, the Veteran underwent a VA examination for her lumbar spine disability. Lasegue's sign was positive on both sides. EMG testing revealed left lower radiculopathy, moderate. The peripheral nerves examination revealed that the Veteran reported left lower weakness, numbness, paresthesias, pain, and impaired coordination. The paresthesia was described as tingling, numbness, and crawling. Motor examination showed muscle strength of 3. The Veteran had to assist leg movement since a stroke. Movement was slow and intentional. There was weakness and atrophic change, generalized in lower extremity. Muscle atrophy was present, but there was no abnormal muscle tone or bulk. There was racheting of major muscle movement, spasm. The Veteran's gait and balance were not normal; she shuffled with intentional leg raising. Reflex examination revealed knee jerk of 2+, ankle jerk of 1+, and plantar flexion was normal bilaterally (1+ is hypoactive and 2+ is normal). Detailed motor examination revealed strength of 3/5 on hip extension, knee extension, ankle dorsiflexion, ankle plantar flexion, and great toe extension bilaterally (3 is active movement against gravity and 5 is active movement against full resistance). Muscle tone was normal and there was no muscle atrophy. Sensory examination revealed vibration, pain (pinprick), light touch, and position sense of 1/2 bilaterally (1 is impaired and 2 is normal). The Veteran's left lower extremity radiculopathy was diagnosed as moderate. A private treatment record dated in November 2009 shows that the Veteran had lumbar radicular syndrome. The Veteran testified at her hearing in June 2010 that she had numbness on her right side and constant pain rated as 8-10/10. The Veteran was provided a VA examination in March 2013. The report reveals a diagnosis of lumbar radiculopathy. The Veteran reported radiculopathy symptoms to her lower extremities since her initial surgery in 1983. The symptoms improved slightly based on her surgical procedures. She stated that her symptoms worsened over the last several years and at one point, she was prescribed Neurontin. The symptoms included moderate constant pain of the right lower extremity, intermittent moderate pain of the left lower extremity, paresthesias, moderate of the right and left lower extremities and moderate numbness of the right and left lower extremities. The examiner indicated that the Veteran had moderate incomplete paralysis of the right and left lower extremities. In response to the Board's question regarding the symptoms of radiculopathy in the Veteran's right lower extremity prior to July 8, 2009, the examiner noted several pieces of evidence dated prior to July 8, 2009, in which the Veteran reported pain that radiated to the legs. With respect to symptoms of radiculopathy in the Veteran's left lower extremity, the examiner again noted the information of pain radiating to the legs. The examiner stated that based on the evidence, the Veteran complained of radiculopathy symptoms since 1983. Again, as noted by the March 2013 VA examiner, the Veteran reported radiculopathy symptoms throughout the period on appeal. The March 2009 private medical record showed that the Veteran complained of painful radicular symptoms. The August 2008 private medical record noted that the Veteran had complained of pain for many years to include pain radiating from the back to the thighs. The September 2006 private medical record noted that the Veteran had worsening radicular symptoms. As the examiner suggested that the Veteran's current symptoms, described as moderate incomplete paralysis, have existed since 1983, the Board finds that the Veteran's radiculopathy of the right lower extremity warrants a 20 percent disability rating, effective February 2, 2005, a year prior to the Veteran's claim for an increased disability rating for chronic back pain with spondylolisthesis L5-S1, s/p fusion, and the radiculopathy of the left lower extremity warrants a 20 percent disability rating effective February 2, 2005. See 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Again, the Board reiterates that the issues on appeal were limited to the period prior to July 8, 2009. Thus, the issue as to whether the Veteran is entitled to a higher disability rating from July 8, 2009 is not before the Board at this time. In addition, the Board finds that a disability rating in excess of 20 percent prior to July 8, 2009 - the period of the appeal that is currently before the Board - is not warranted. A 40 percent disability rating requires moderately severe incomplete paralysis of the sciatic nerve. The medical evidence shows that the Veteran has diminished muscle strength and pain down her legs. The October 2007 record shows that the Veteran reported radicular symptoms in both lower extremities. The July 2009 VA examination report shows that the Veteran exhibited numbness, weakness, pain, paresthesias, diminished muscle strength and atrophy; however, the examiner noted that the muscle tone was normal and the Veteran exhibited 3/5 strength during the detailed motor examination. The examiner also stated that the Veteran's left lower extremity radiculopathy was moderate. In addition, the March 2013 VA examiner also determined that the Veteran had moderate incomplete paralysis. In light of the above, the Board finds that the Veteran's left lower extremity radiculopathy and right lower extremity radiculopathy are more akin to a moderate incomplete paralysis. Therefore, a disability rating in excess of 20 percent is not warranted at any period on appeal (prior to July 8, 2009). See Fenderson, id. As a preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the claim is denied. 38 U.S.C.A. § 5107(b). Extraschedular Consideration The Board must adjudicate the issue of whether referral for consideration of extraschedular ratings is warranted. In this instance, the Veteran's service-connected radiculopathy of the right and left lower extremities are fully accounted for under Diagnostic Code 8620. The ratings assigned are commensurate with the level of disablement shown as to each disability and there is otherwise no indication that there are present signs or symptoms beyond the scope of the applicable rating criteria. Rather, the rating criteria describe adequately and contemplate the current disability level of the disorders in question, and, as such, the question of extraschedular consideration need not proceed further, as there exists no basis for the assignment of extraschedular ratings with respect to any period under consideration herein. Scars Historically, the July 2010 Board decision granted entitlement to a separate disability rating of 10 percent for the Veteran's painful scars effective June 10, 2010 - the first evidence revealing evidence of painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). The Veteran's scars were considered part of the Veteran's claim for an increased disability rating for lumbosacral spine spondylolisthesis L5-S1, status post fusion. In the Joint Motion for Remand, the parties indicated that the Board did not consider whether the Veteran was entitled to separate ratings for each scar. Following the Joint Motion for Remand, the Veteran was assigned a 20 percent disability rating for painful scars, effective September 17, 2011. During the pendency of the Veteran's appeal, the regulations pertaining to rating skin disabilities were revised, effective October 23, 2008. However, those revised provisions are applicable only to claims received on or after October 23, 2008, unless the Veteran specifically requests consideration of the revised regulations. Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are deep or that cause limited motion. Scars that are deep or that cause limited motion in an area or areas exceeding 6 square inches (39 sq. cm.) are rated 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 sq. cm.) are rated 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) are rated 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq. cm.) are rated 40 percent disabling. Diagnostic Code 7802 provides ratings for scars, other than the head, face, or neck, that are superficial or that do not cause limited motion. Superficial scars that do not cause limited motion, in an area or areas of 144 square inches (929 sq. cm.) or greater, are rated 10 percent disabling. Note (1) to Diagnostic Code 7802 provides that scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7803 provides a 10 percent rating for superficial unstable scars. Note (1) to Diagnostic Code 7803 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7804 provides a 10 percent rating for superficial scars that are painful on examination. Note (1) to Diagnostic Code 7804 provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7805 provides that other scars are to be rated on limitation of function of affected part. 38 C.F.R. § 4.118. The Veteran was provided a VA examination in March 2006. Examination revealed a surgical scar on the lumbar spine that measured 24 centimeters midline that was hyperpigmented without erythema or edema, but there was significant keloid formation of the area. The scar was not tender. The Veteran also had scars to the left and right of the lumbar spine. On the left side, the scar was 12 centimeters in diameter, and on the right side, it was 10 centimeters in diameter that was consistent also with her back surgery. The scars were hyperpigmented without erythema or edema, but there was keloid formation; the scars were self-limiting. During the June 10, 2010 hearing, the Veteran testified that her scars were painful. The September 2011 VA examination report noted that the Veteran had four painful scars. The scars were not unstable. With respect to the right lower extremity, it was indicated that there was a linear scar of 18.5 cm. by .5 cm. The posterior trunk had three scars, all of which were linear. Scar #1 measured 12.5 by .5 cm., scar #2 was 12 cm. by .5 cm., scar #3 was 22.5 cm. by .5 cm. The scars did not result in limitation of function. The Veteran was provided a VA examination in March 2013. The examiner indicated that the Veteran had five scars: midline posterior scar (multiple surgeries); left hip scar (bone graft site); right hip scar (bone graft site); right lateral calf scar (bone graft harvest site); and left of midline scar (anterior-posterior approach for lumbar fusion and placement of fixation device). The examiner noted that the five scars were painful. The Veteran reported mild to moderate tenderness to all scars. The scars were not unstable. With respect to the right lower extremity, the scar was located on the right lateral calf and the length of the scar was 20 cm. With respect to the anterior trunk, there was a left of midline scar. The scar measured 16 cm. With respect to the posterior trunk, the lumbar spine scar measured 25 cm., the right hip scar measured 16 cm., and the left hip scar measured 16 cm. The examiner then indicated that the scars were superficial and non-linear. The scar affecting the right lower extremity was approximately 10 cm2, the scar affecting the anterior trunk, measured a total area of 16 cm2 and the scars of the posterior trunk measured a total area of 41 cm2. The scars did not result in limitation of function. The examiner indicated that the scars were less likely as not tender from February 2, 2006 to June 10, 2010 as the VA examination in July 2009 demonstrated evaluation of scars, but no tenderness was noted. The examiner did note that not all scars were evaluated for tenderness during the July 2009 VA examination. There were no objective findings of tenderness to the scars during this time frame. The examiner stated that for the period of June 10, 2010 to September 17, 2011, it was at least as likely as not that the Veteran's post-operative scars were tender based on the September 2011 VA examination report. In light of the above evidence, the Board finds that the Veteran is entitled to a separate 10 percent disability rating for each scar, effective June 10, 2010, under Diagnostic Code 7804. 38 C.F.R. § 4.118. The Board notes that the evidence is conflicting as to the number of the Veteran's scars. However, the March 2013 VA examiner provided the most detailed information regarding the Veteran's scars and indicated that it was "at least as likely as not" that the scars have been tender since June 10, 2010. Therefore, a 10 percent disability is warranted for the midline posterior scar, right hip scar, left hip scar, right lateral calf scar, and left of midline scar. However, a separate rating or ratings for scars are not warranted prior to June 10, 2010. The evidence does not reflect that the scars were deep or caused limitation of motion, involved areas of 144 square inches or greater, the scars were not described as unstable and were not shown to be painful prior to June 10, 2010. Therefore, the preponderance of the evidence is against the claim and separate compensable rating/ratings for scars prior to June 10, 2010 is denied. 38 U.S.C.A. § 5107(b). In making the above determination, the Board notes that the RO granted a single rating of 20 percent for all of the Veteran's five scars which was effective September 17, 2011. In fact, the Veteran meets the criteria under Diagnostic Code 7804 (2012) for a higher rating of 30 percent for five or more painful scars. However, as the Board has granted separate disability ratings of 10 percent for each of the five scars, this is more beneficial to the Veteran as the separate disability ratings combined are greater than the single 30 percent disability rating for scars. See 38 C.F.R. § 4.25. Extraschedular Consideration The Board must adjudicate the issue of whether referral for consideration of extraschedular ratings is warranted. In this instance, the Veteran's scars are rated under Diagnostic Code 7804 and the Board has provided separate ratings of 10 percent for each scar based on the manifestations of pain. The ratings assigned are commensurate with the level of disablement shown as to each disability and there is otherwise no indication that there are present signs or symptoms beyond the scope of the applicable rating criteria. Rather, the rating criteria describe adequately and contemplate the current disability level of the disorders in question, and, as such, the question of extraschedular consideration need not proceed further, as there exists no basis for the assignment of extraschedular ratings with respect to any period under consideration herein. TDIU Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities; provided that, if there is only one such disability, this disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a); see also 38 C.F.R. §§ 3.340, 3.341. For purposes of one 60 percent disability or one 40 percent disability in combination, disabilities of a common etiology or from a single accident are considered to be one disability. 38 C.F.R. § 4.16(a). Here, the Veteran is service-connected for chronic back pain with spondylolisthesis L5-S1, status post fusion, rated as 40 percent disabling; left lower extremity radiculopathy, rated as 20 percent disabling; right lower extremity radiculopathy, rated as 20 percent disabling; midline posterior scar, rated as 10 percent disabling, effective June 10, 2010, left hip scar rated as 10 percent disabling, effective June 10, 2010, right hip scar rated as 10 percent disabling, effective June 10, 2010, right lateral calf scar, rated as 10 percent disabling, effective June 10, 2010, left of midline scar, rated as 10 percent disabling, effective June 10, 2010. 38 C.F.R. § 4.16(a) directs that for the purpose of one 60 percent disability or one 40 percent disability in combination, disabilities resulting from common etiology or a single accident will be considered as one disability. Here, the Veteran's radiculopathy and chronic back pain disabilities are considered one disability. In utilizing the bilateral factor for the left lower extremity radiculopathy and right lower extremity radiculopathy, and the chronic back pain with spondylolisthesis L5-S1, status post fusion, the Veteran has a single 60 percent disability rating. 38 C.F.R. §§ 4.16(a); 4.26. Therefore, the pertinent inquiry is whether the Veteran is unable to secure and follow a substantially gainful occupation by reason of her service-connected disabilities. The SSA records show that the Veteran complained of severe back pain. The SSA determination noted that the Veteran was considered disabled in February 1994 from a disorder of the back and affective disorder. The Veteran was provided a VA examination in March 2013. The examiner stated that based on her service-connected disabilities, review of multiple examinations and the claims file, it was at least as likely as not that the Veteran would be precluded from working in any occupations including sedentary, light duty or strenuous labor. In response to the Board's question as to whether the Veteran's impairments were present from February 2, 2006, the examiner opined that it was at least as likely as not that the impairments were present from February 2, 2006. In light of the above, the Board finds that the probative and persuasive evidence reflects that the Veteran is unable to secure and follow a substantially gainful occupation by reason of his service-connected disabilities. As noted above, the Veteran had a qualifying 60 percent disability rating since February 2, 2005, a year prior to the date for the increased rating claim for chronic back pain with spondylolisthesis L5-S1, status post fusion and the evidence shows that the Veteran has been unemployed since that time. Thus, in resolving any doubt in favor of the Veteran, February 2, 2005 is the earliest effective date assignable for the grant of entitlement to a TDIU. See 38 U.S.C.A. § 5107(b). ORDER Effective February 2, 2005, a disability rating of 40 percent for chronic back pain with spondylolisthesis L5-S1, status post fusion, but no higher, is granted, subject to the regulations governing the payment of monetary awards. Effective February 2, 2005, a disability rating of 20 percent for left lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. Effective February 2, 2005, a disability rating of 20 percent for right lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. Effective June 10, 2010, a 10 percent disability rating for midline posterior scar is granted, subject to the regulations governing the payment of monetary awards. Effective June 10, 2010, a 10 percent disability rating for left hip scar is granted, subject to the regulations governing the payment of monetary awards. Effective June 10, 2010, a 10 percent disability rating for right hip scar is granted, subject to the regulations governing the payment of monetary awards. . Effective June 10, 2010, a 10 percent disability rating for right lateral calf scar is granted, subject to the regulations governing the payment of monetary awards. Effective June 10, 2010, a 10 percent disability rating for left of midline scar is granted, subject to the regulations governing the payment of monetary awards. Entitlement to a TDIU is granted, effective February 2, 2005, subject to the regulations governing the payment of monetary awards. ______________________________________________ L.M. BARNARD Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs