Citation Nr: 1322487 Decision Date: 07/15/13 Archive Date: 07/24/13 DOCKET NO. 09-18 253 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUES 1. Entitlement to an initial compensable rating for cervical sprain/strain with herniated discs prior to June 29, 2007. 2. Entitlement to an initial rating in excess of 10 percent for cervical sprain/strain with herniated discs from June 29, 2007 to January 22, 2009. 3. Entitlement to an initial rating greater than 20 percent for cervical sprain/strain with herniated discs beginning January 23, 2009. 4. Entitlement to an initial compensable rating for lumbar sprain/strain with herniated discs prior to January 23, 2009. 5. Entitlement to an initial rating greater than 40 percent for lumbar sprain/strain with herniated discs beginning January 23, 2009. 6. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to posttraumatic stress disorder (PTSD) for the time period prior to February 12, 2008. 7. Entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C.A. § 1114(s) prior to February 12, 2008. 8. Entitlement to SMC pursuant to 38 U.S.C.A. § 1114(s) beginning on February 12, 2008 (except for the time period from December 30, 2008 to February 28, 2009, during which SMC has been granted). REPRESENTATION Appellant represented by: John S. Berry, Attorney ATTORNEY FOR THE BOARD E. Joyner, Counsel INTRODUCTION The Veteran served on active duty from December 1982 to April 1983 and from July 2004 to May 2006. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania and a March 2011 rating decision of the RO in Reno, Nevada. Jurisdiction of the case currently resides with the RO in Reno, Nevada. The May 2007 rating decision, in pertinent part, granted service connection for cervical sprain/strain with herniated cervical discs and lumbar sprain/strain with herniated lumbar discs. A noncompensable rating was assigned for each disability, and each rating was made effective May 23, 2006. Thereafter, in May 2009, the RO increased the rating for cervical sprain/strain with herniated discs to 20 percent effective January 23, 2009, and increased the rating for lumbar sprain/strain with herniated discs to 40 percent, also effective January 23, 2009. When the case was before the Board in November 2011, the Board, in part, denied a compensable rating for cervical sprain/strain with herniated discs prior to June 29, 2007, granted a 10 percent for cervical sprain/strain with herniated discs from June 29, 2007 to January 22, 2009 (but denied a rating in excess of 10 percent for this time period), denied a rating in excess of 20 percent for cervical sprain/strain with herniated discs beginning January 23, 2009, denied a compensable rating for lumbar sprain/strain with herniated discs prior to January 23, 2009, and denied a rating in excess of 40 percent for lumbar sprain/strain with herniated discs beginning January 23, 2009. The Veteran appealed the above listed denials to the Court of Appeals for Veterans Claims (Court). In a July 2012 Order, the Court granted a Joint Motion for Remand and remanded the part of the Board's decision to the extent that it denied entitlement to a compensable rating for service-connected cervical sprain/strain with herniated discs prior to June 29, 2007; denied a rating in excess of 10 percent for cervical sprain/strain with herniated discs from June 29, 2007 to January 22, 2009; denied a rating in excess of 20 percent for cervical sprain/strain with herniated discs beginning January 23, 2009; denied a compensable rating for lumbar sprain/strain prior to January 23, 2009; and denied a rating in excess of 40 percent for lumbar sprain/strain beginning January 23, 2009. The Joint Motion for Remand specifically notes that all other issues decided by the Board should not be disturbed. However, it was specifically noted that clarification was needed regarding the Veteran's claim of entitlement to service connection for a skin disability. Notably, in the November 2011 Board decision/remand, the Board listed in the Order section that the claim of entitlement to service connection for a skin disability was denied. However, the issue was discussed only in the remand portion of the decision/remand. The issue of entitlement to service connection for a skin disability was meant to be remanded only, not denied, in the November 2011 Board decision/remand. As such, the development requested by the November 2011 remand should be undertaken. The Board also notes that implementation of the Board's November 2011 decision by the RO in an August 2012 rating decision was delayed pending clarification from the Board regarding two issues. The Board is providing clarification of these two issues in a separate Corrective Order. Initially, the Board notes that with respect to the issue of entitlement to a TDIU, the Veteran met the minimum schedular criteria for a TDIU as of February 12, 2008, and was also found to be unemployable due to his PTSD alone and due to his residuals of traumatic brain injury (TBI) alone during this time period. As such, and as described in the Corrective Order, the Board grants entitlement to a TDIU for the time period beginning on February 12, 2008. Additionally, the August 2012 rating decision indicates that clarification was needed from the Board regarding the issue of entitlement to an initial rating in excess of 10 percent for degenerative changes and subluxation of the left acromioclavicular joint of the left shoulder. In this regard, the Board notes that in the separate Corrective Order, the Board corrects the Conclusion of Law and Order sections of the November 2011 Board decision to reflect that a 20 percent rating, but no greater, is warranted from May 23, 2006 to April 1, 2007, and a 10 percent rating, but no higher, is warranted beginning April 2, 2007, for degenerative changes and subluxation of the left acromioclavicular joint. Pursuant to the November 2011 Board decision, the issues of entitlement to service connection for residuals of lateral right thigh and calf skin graft claimed as scar, entitlement to service connection for a skin condition, entitlement to service connection for a nasal/nose disability to include on a secondary basis, entitlement to service connection for a sleep disorder, to include on a secondary basis, entitlement to service connection for residuals of a tonsillectomy to include on a secondary basis, entitlement to a rating greater than 30 percent for PTSD prior to February 21, 2006, entitlement to a rating greater than 50 percent for PTSD from February 21, 2008 to September 13, 2009, entitlement to a rating greater than 70 percent for PTSD beginning September 14, 2009, entitlement to a rating greater than 40 percent for TBI prior to September 14, 2009, and entitlement to a rating greater than 70 percent for TBI beginning September 14, 2009 were remanded for additional development. A review of the record reveals that the development directed by the Board in November 2011 regarding these remanded claims has not been undertaken, and these claims have not been returned to the Board. Accordingly, the Board does not have jurisdiction over these above listed claims at this time. VA has a well-established duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. (2008). Under this duty to maximize benefits, SMC benefits are to be accorded when a Veteran becomes eligible without need for a separate claim. See Bradley, 22 Vet. App. 280, 294 (2008). In a May 2009 rating decision, the RO granted SMC housebound benefits from December 30, 2008 through February 28, 2009, the time period that a 100 percent temporary total disability rating based upon convalescence for the Veteran's service-connected left shoulder disability was granted. In March 2011 the Veteran filed a claim for SMC based upon housebound status and in a March 2011 rating decision, the RO denied the claim for SMC housebound benefits. The Veteran filed a timely notice of disagreement, the RO issued a statement of the case in September 2011, and the Veteran filed a timely substantive appeal with respect to the decision. Although it is not clear that the issue was actually certified to the Board, pursuant to Bradley and Buie, the Board has included the issue of entitlement to SMC for the relevant period as part of the appeal, as reflected on the title page. The issues of entitlement to a TDIU due to PTSD for the time period prior to February 12, 2008, and entitlement to SMC pursuant to 38 U.S.C.A. § 1114(s) prior to February 12, 2008 are addressed in the REMAND portion of the decision below and are REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. For the time period prior to June 29, 2007, the Veteran's cervical sprain/strain was manifested by painless forward flexion of the cervical spine to 45 degrees, combined range of motion of the cervical spine of 340 degrees; there was no evidence of functional loss beyond that contemplated by the current rating, muscle spasm, guarding, localized tenderness, vertebral body fracture, intervertebral disc syndrome requiring bed rest prescribed by a physician, or associated neurological impairment. 2. For the time period from June 29, 2007 to January 22, 2009, the Veteran's cervical sprain/strain has been manifested by forward flexion of the cervical spine to 45 degrees and combined range of motion of 185 degrees; there was no evidence of functional loss beyond that contemplated by the current rating, muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour, intervertebral disc syndrome requiring bed rest prescribed by a physician, or associated neurological impairment. 3. For the time period from January 23, 2009, the Veteran's cervical sprain/strain has been manifested by forward flexion of the cervical spine to 30 degrees and combined range of motion of no less than 105 degrees; there is no evidence of ankylosis, functional loss beyond that contemplated by the current rating, intervertebral disc syndrome requiring bed rest prescribed by a physician totaling two weeks or more during the previous 12-month period, or associated neurological impairment. 4. For the time period prior to January 23, 2009, the Veteran's lumbar sprain/strain was manifested by painless flexion to 90 degrees, combined range of motion of the thoracolumbar spine greater than 235 degrees; there was no evidence of muscle spasm, guarding, or localized tenderness, vertebral body fracture, functional loss beyond that contemplated by the current rating, intervertebral disc syndrome requiring bed rest prescribed by a physician, or associated neurological impairment. 5. For the time period from January 23, 2009, the Veteran's lumbar sprain/strain has been manifested by forward flexion of the thoracolumbar spine to at worst 10 degrees; there was no evidence of unfavorable ankylosis of the entire thoracolumbar spine or of the entire spine, functional loss beyond that contemplated by the current rating, intervertebral disc syndrome requiring bed rest prescribed by a physician totaling two weeks or more during the previous 12-month period, or associated neurological impairment. 6. As of February 12, 2008, the Veteran is in receipt of a TDIU based solely on his PTSD and his remaining service-connected disabilities of TBI, headaches, cervical sprain/strain with herniated discs, and degenerative changes and subluxation of the left acromioclavicular joint of the left shoulder, are ratable as 70 percent disabling when combined. CONCLUSIONS OF LAW 1. The criteria for an initial compensable schedular rating for cervical sprain/strain with herniated discs for the time period prior June 29, 2007 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2012). 2. The criteria for an initial schedular rating in excess of 10 percent for cervical sprain/strain with herniated discs for the time period from June 29, 2007 to January 22, 2009 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2012). 3. The criteria for an initial schedular rating in excess of 20 percent for cervical sprain/strain with herniated discs for the time period beginning January 23, 2009 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2012). 4. The criteria for an initial schedular compensable rating for lumbar sprain/strain with herniated discs for the time period prior to January 23, 2009 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2012). 5. The criteria for an initial schedular rating in excess of 40 percent for lumbar sprain/strain with herniated discs for the time period beginning January 23, 2009 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2012). 6. The criteria for SMC based upon housebound status have been met for the time period beginning February 12, 2008. 38 U.S.C.A. §§ 1114(s), 5103, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.350 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA has met all statutory and regulatory notice and duty to assist provisions. See 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, 3.326 (2012). A letter dated in March 2007 satisfied the duty to notify provisions. The March 2007 letter notified the Veteran of regulations pertinent to the establishment of an effective date and of the disability rating. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess/Hartman v. Nicholson, 19 Vet. App. 2006). Once a claim for service connection has been substantiated, the filing of a notice of disagreement with the initial rating of the disability on appeal, as the Veteran did in February 2008 with respect to his service-connected cervical and lumbar sprain/strain, does not trigger additional 38 U.S.C.A. § 5103(a) notice. Therefore, any defect as to notice is non-prejudicial. See id; Dunlap v. Nicholson, 21 Vet. App. 112 (2007); see also Goodwin v. Peake, 22 Vet. App. 128, 134 (2008) (where a claim has been substantiated after August 29, 2000, the appellant bears the burden of demonstrating any prejudice from defective notice with respect to any downstream elements). In this decision the Board grants entitlement to entitlement to SMC based upon housebound status as of February 12, 2008, which constitutes a complete grant of the Veteran's claim for this time period. The claim involving the time period prior to February 12, 2008 has been remanded. Therefore, no discussion of VA's duty to notify or assist is necessary. VA spine examinations were conducted in April 2007, January 2009 and September 2009. The Veteran has not argued, and the record does not reflect that these examinations were inadequate for rating purposes. The examinations were adequate because they were based on an examination of the Veteran and provided sufficient information to address the rating criteria for the disabilities on appeal. 38 C.F.R. § 3.159(c)(4); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). There is no indication in the record that any additional evidence relevant to the issues decided herein is available and not part of the claims file. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of the case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman, 19 Vet. App. at 486; Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009). Legal Analysis Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities (Rating 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 Rating 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). Where the Rating Schedule does not provide for a noncompensable evaluation for a diagnostic code, a noncompensable evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (2012). 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). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. 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). Service connection for cervical sprain/strain with herniated discs was granted in the May 2007 rating decision, and an initial noncompensable percent rating was assigned effective May 23, 2006, under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5237. The May 2007 rating decision also granted service connection for lumbar sprain/strain with herniated discs, and an initial noncompensable rating was assigned effective May 23, 2006, also under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5237. In a May 2009 statement of the case, the RO granted an increased rating of 20 percent rating for cervical sprain/strain with herniated discs, effective January 23, 2009, and granted a 40 percent rating for lumbar sprain/strain with herniated discs, effective January 23, 2009. In the November 2011 Board decision, the Board granted an increased rating of 10 percent, but no higher, for cervical sprain/strain with herniated discs from June 29, 2007 to January 22, 2009. As such, the Veteran's cervical sprain/strain is currently rated as noncompensable prior to June 29, 2007, as 10 percent disabling from June 29, 2007 to January 22, 2009, and as 20 percent disabling beginning January 23, 2009. The Veteran's lumbar sprain/strain is currently rated as noncompensable prior to January 23, 2009, and as 40 percent disabling from January 23, 2009. Diagnostic Code 5237 is subsumed into the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or the 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 warrants a 10 percent rating. 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 warrants a 20 percent rating. 38 C.F.R. § 4.71a, General Rating Formula (2012). Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine warrants a 40 percent rating; unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating; and unfavorable ankylosis of the entire spine warrants the maximum 100 percent rating. Id. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury or surgical procedure. See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 93 (30th ed., 2003). Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). In every instance where a zero percent evaluation is not provided for, such shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (2012). I. Cervical Sprain/Strain with Herniated Discs The evidence of record does not support an initial compensable rating prior to June 29, 2007, greater than a 10 percent rating from June 29, 2007 to January 22, 2009, or greater than a 20 percent rating beginning on January 23, 2009 for the Veteran's cervical sprain/strain with herniated discs based on the General Rating Formula. The medical evidence includes a May 2006 cervical spine MRI report. The report reflects an impression of midline disc herniation at C4-5 and C5-6. The medical evidence also reflects that the Veteran underwent a VA examination in April 2007. The report of that examination reflects that the Veteran had painless active and passive flexion from zero to 45 degrees, painless active and passive extension from zero to 45 degrees, painless active and passive right and left lateral flexion from zero to 45 degrees, and painless active and passive right and left lateral rotation from zero to 80 degrees. The examiner opined that there is no additional limitation of motion or joint function due to pain, fatigue, weakness, or lack of endurance or on repetitive use or during flare-ups. The examiner indicated that the Veteran's cervical sprain/strain with herniated discs cause no significant effects on his usual occupation but cause problems with his usual daily activities. Specifically, the effect on chores, exercise, and recreation was noted to be mild and the effect on sports was noted to be moderate. There was no effect on shopping, feeding, and bathing. Motor and nerve function tests were normal. A June 2007 VA Physical Therapy Evaluation note indicates that the Veteran complained of stiffness in his neck. On examination bilateral lateral rotation was to 20 degrees on each, forward flexion was full, extension was to 10 degrees, and bilateral lateral flexion was full, to 45 degrees on each side. The Veteran described the pain as a 3-4 out of 10. The pain was described as stiffness in the neck. A February 2008 radiology report notes a diagnosis of mild C4-5 degenerative disc disease. A May 2008 VA treatment record notes that the Veteran's upper extremity strength was within full limits. An October 2008 VA radiology report indicates that there are mild degenerative changes of the cervical spine. An October 2008 VA treatment record notes the Veteran's complaints of chronic residual pain without radicular symptoms or weakness. An October 2008 private MRI report indicates that there is straightening of the normal cervical lordosis with degenerative changes of the cervical spine, C4-5 intervertebral disc protrusion, C5-6 intervertebral disc bulge with mild bilateral neural foraminal narrowing, and C6-7 intervertebral disc bulge with mild neural foraminal narrowing on the left. A November 2008 VA treatment record notes that the Veteran complained of neck pain. Range of motion of the cervical spine was essentially normal. The Veteran indicated that his neck felt better when it is flexed. A January 2009 VA examination report notes that there is a history of fatigue, decreased motion, stiffness, weakness, spasms, and cervical spine pain. The Veteran described moderate, sharp, constant daily pain. He also described weekly flare-ups that are severe and last hours. Flare-ups are brought on by getting in and out of the car, and driving. They are relieved by time. The Veteran indicated that during flare-ups include a 50 percent reduction in functional impairment. Examination revealed no spasm, atrophy or guarding of the cervical sacrospinalis. There was no pain on motion, tenderness, or weakness. Sensory examination of the upper extremities was normal for vibration, pain (pinprick), light touch, and position sense. Reflex examination of the upper extremities was normal. Range of motion of the cervical spine included flexion from zero to 30 degrees, extension was from zero to 20 degrees, right and left lateral flexion was from zero to 30 degrees, left lateral rotation was from zero to 30 degrees, and right lateral rotation was from zero to 45 degrees. There was no objective evidence of pain on active range of motion. There was no objective evidence of pain following repetitive motion, and there was no additional limitation after three repetitions of range of motion. Lasegue's sign was negative. The examiner opined that the subjective complaints correlate with physical findings. The examiner found positive DeLuca for the cervical spine. The examiner stated that there are incapacitating episodes but no intervertebral disc syndrome. It was noted that there are incapacitating episodes of the cervical spine. The examiner stated that this occurred 12 times and he stayed in bed one day during the past 12-month period. The examiner stated that there is no cervical spine ankylosis. The examiner stated that the Veteran's cervical ligamentous strain with herniated discs causes no effect on feeding, but causes a severe effect on chores, shopping, exercise, sports, recreation, traveling, bathing, dressing, toileting, and grooming. An April 2009 VA treatment record notes that cervical flexion was to 30 degrees, extension was to 30 degrees, right and left rotation were both to 15 degrees, left lateral flexion was to 10 degrees and right lateral flexion was to five degrees. An April 2009 VA pain management note indicates that the Veteran's cervical range of motion was moderately decreased in flexion, extension, and bilateral side bending. There was no palpatory tenderness in the bilateral cervical paraspinals. Motor strength in the upper extremities was 4+/5. A September 2009 VA examination report notes that in service in October 2005 the Veteran was a rear security gunner facing backwards and the vehicle rolled over at 65 miles per hour. The Veteran was thrown from the vehicle, landing on his back and on the back of his head. He described a history of weakness or paralysis of the upper extremity. There is no history of paresthesias, numbness, memory loss, poor coordination, vision loss, speech difficulty or other symptoms. The Veteran's coordination was normal. There was no evidence of sensory loss. Deep tension reflexes were normal on the left (2+), and 1+ on the right. Later in the examination, all upper extremity reflexes were normal. The Veteran complained of neck pain and lack of range of motion since the accident. It was noted that he uses a neck collar for traction at times. The Veteran denied numbness, paresthesias, and fatigue. He endorsed symptom s of decreased motion, stiffness, weakness, and pain. He stated that the pain is mild, daily, and lasts hours. He denied having flare-ups of his spinal conditions. Examination of the spine revealed normal posture, head position, symmetry, and gait. There was no gibbus, kyphosis, list, lumbar flattening, lumbar lordosis, scoliosis, reverse lordosis or cervical spine ankylosis. Objective examination of the cervical sacrospinalis revealed no spasm, atrophy, guarding, weakness, or pain with motion. There was tenderness on the right and left. Motor examination revealed full strength (5/5) on the right and near full strength (4/5 on the left). Sensory examination of the upper extremities was normal in terms of vibration, pain, light touch, and position sense. Detailed reflex examination was normal for biceps, triceps, brachioradialis, and finger jerk bilaterally. Range of motion testing revealed active flexion from zero to 40 degrees, extension from zero to 10 degrees, left lateral flexion and rotation from zero to 30 degrees, and right lateral flexion and rotation from zero to 25 degrees. There was objective evidence of pain on active range of motion. The examiner stated that there was no additional limitation after three repetitions of range of motion. Lasegue's sign was negative. The examiner opined that Wadell's sign was positive with complaints of neck pain with one pound axial loading. The examiner opined that there was exaggeration appreciation regarding the Veteran's degreased range of motion testing using the goniometer as compared to the additional movement observed during the interview period. The examiner estimated actual cervical range of motion to be 50 degrees of flexion, 20 degrees of extension, and 70 degrees of right and left lateral rotation. The examiner did not estimate lateral flexion, as this range of motion was not spontaneously done by the Veteran. Imaging studies of the cervical spine revealed stable minimal degenerative changes. The examiner opined that the Veteran's cervical spine disability caused no effect on his feeding, bathing, dressing, toileting, and grooming. It caused a mild effect on his chores, shopping, and recreation. It caused a moderate impact on his exercise, sports, and traveling. The VA examiner opined that the Veteran's cervical spine diagnosis can affect his ability to perform physical employment. An October 2011 private MRI report notes that that there was mild progression in degenerative change of the cervical spine since the October 2008 MRI. It was noted that there was C4-5 progression in intervertebral disc protrusion with annular tear and moderate right with mild left neural foraminal narrowing, C5-6 progressive intervertebral disc protrusion with any tear an moderate bilateral neural foraminal narrowing, and C6-7 persistent intervertebral disc bulge with mild left neural foraminal narrowing. Based upon the evidence of record for the time period prior to June 29, 2007, a compensable rating based upon limitation of motion is not warranted. Initially, the Board notes that at the April 2007 VA examination, the Veteran could flex and extend his cervical spine to a full 45 degrees without pain. The combined range of motion of the cervical spine was also a full 340 degrees. Additionally, the evidence for this time period does not reflect that there was any muscle spasm, guarding, localized tenderness, or vertebral body fracture with loss of 50 percent or more of the height. Therefore, a higher rating is not warranted based upon limitation of motion for this time period. The evidence of record also does not show that the Veteran's cervical sprain/strain with herniated discs causes a level of functional loss greater than that already contemplated by the assigned noncompensable rating prior to June 29, 2007. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). During the time period prior to June 29, 2007, the evidence reflects that the Veteran experienced no pain during any range of motion of the cervical spine. Moreover, the April 2007 VA examiner found that there was no additional limitation of motion or joint function due to pain, fatigue, weakness, or lack of endurance on repetitive use or during flare-ups. The remainder of the medical evidence for this time period also does not reflect any such additional limitation of motion or joint function. As such, there is no greater functional loss than that already contemplated by the assigned noncompensable rating prior to June 29, 2007. During the time period from June 29, 2007 to January 22, 2009, a higher, 20 percent rating based upon limitation of motion is not warranted. Initially, the Board notes that at the June 29, 2007 VA physical therapy evaluation, flexion of the cervical spine was full, to 45 degrees. Combined range of motion of the cervical spine was to 185 degrees. Moreover, the range of motion of the cervical spine was found to be normal in November 2008. Therefore, a higher rating is not warranted on the basis of limitation of motion. The evidence for this time period also does not reflect muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Therefore, a rating in excess of 10 percent is not warranted based upon limitation of motion for the time period from June 29, 2007 to January 22, 2009. The evidence of record also does not show that the Veteran's cervical sprain/strain with herniated discs causes a level of functional loss greater than that already contemplated by the assigned 10 percent rating from June 29, 2007 to January 22, 2009. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). During this time period the evidence reflects that the Veteran experienced pain which was rated as 3 or 4 out of 10, and was described as stiffness in the neck. Pain on motion was not described, and the evidence does not show any additional limitation of motion or joint function due to pain, fatigue, weakness, or lack of endurance on repetitive use or during flare-ups. As such, there is no greater functional loss than that already contemplated by the assigned 10 percent rating from June 29, 2007 to January 22, 2009. For the time period beginning on January 23, 2009, a higher rating based upon limitation of motion is not warranted. As forward flexion of the cervical spine is not limited to 15 degrees or less for the time period beginning on January 23, 2009, an initial rating greater than 20 percent is not warranted under the General Rating Formula. In this regard, the Board notes that at the January 2009 VA examination, forward flexion of the cervical spine was to 30 degrees and the combined range of motion of the cervical spine was to 185 degrees. On repetitive testing, range of motion did not change. Moreover, in January 2009 there was no spasm, guarding, or tenderness. An April 2009 VA treatment record notes that flexion was also to 30 degrees and combined range of motion was 105 degrees. Also in April 2009, there was no tenderness in the bilateral cervical paraspinals. The September 2009 examination revealed that flexion of the cervical spine was to 40 degrees. Notably, the September 2009 VA examiner opined that there was some exaggeration on the part of the Veteran in terms of loss of motion, and the examiner estimated actual cervical range of motion to be 50 degrees of flexion. Combined range of motion on examination (actual, not estimated) was 160 degrees in September 2009. Furthermore, examination revealed that gibbus, kyphosis, list, scoliosis, reverse lordosis and cervical spine ankylosis were not present. Objective examination also revealed no spasm, guarding, weakness, or pain on motion. Therefore, a rating in excess of 20 percent is not warranted based upon limitation of motion for this time period. The evidence of record also does not show that the Veteran's cervical sprain/strain with herniated discs causes a level of functional loss greater than that already contemplated by the assigned 20 percent rating from January 23, 2009. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). In this regard, during this time period, there is some evidence that the Veteran experienced pain during forward flexion and other ranges of motion of the thoracolumbar spine. The Board also recognizes the Veteran's complaints of decreased motion, stiffness, weakness, and pain during this time period. However, the Veteran was found to be exaggerating his loss of range of motion in September 2009 and both the January 2009 and September 2009 VA examiners found no objective evidence of pain following repetitive motion and no additional limitation after three repetitions of range of motion. The January 2009 VA examiner found that the Veteran's subjective complaints correlated with his physical findings and also found that the DeLuca criteria were met. However, the examiner did not describe the additional loss of motion due to such symptoms as pain, fatigue, weakness, lack of endurance, or incoordination in terms of additional degrees of motion lost. Moreover, in January 2009 the Veteran described flare-ups that cause a 50 percent reduction in functional impairment; yet, the September 2009 VA examination report indicates that the Veteran denied flare-ups. With respect to the Veteran's January 2009 statement that his flare-ups cause a 50 percent reduction in range of motion, the Board finds that any additional loss of motion due to pain, fatigue, weakness, lack of endurance, or incoordination during such flare-ups does actually not result in loss of flexion more closely approximating 15 degrees or less (a 50 percent reduction). Notably, even after three repetitions in both January 2009 and September 2009, range of motion of the cervical spine did not decrease even one degree. As such, the Board acknowledges that the Veteran's loss of motion/functional loss certainly will increase during a flare-up, but the objective evidence of record does not demonstrate that flexion more nearly approximates 15 degrees or less during such a flare-up. In this regard, the Board finds that if there was such a drastic loss of range of motion during such a flare-up (i.e., a 50 percent loss), there would be some correlation in terms of some degrees of range of motion lost on repetitive motion examination. Because there was absolutely no loss of motion demonstrated on examination after three repetitions in January and September 2009, the Board finds that although range of motion/functional loss during a flare-up exists, it does not amount to a 50 percent loss. In sum, the evidence tends to show that any additional loss of motion due to flare-ups or repetitive use is contemplated by the currently assigned 20 percent rating for the time period beginning on January 23, 2009. See id.; see also 38 C.F.R. § 4.71a, General Rating Formula; Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Therefore, the record does not establish the existence of functional loss for the purposes of 38 C.F.R. §§ 4.40 and 4.45 beyond that contemplated in the currently assigned ratings for the appropriate time periods. The provisions of 38 C.F.R. § 4.71a indicate that intervertebral disc syndrome should be evaluated under the General Rating Formula or under the Formula for Rating Intervertebral Disc Syndrome, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. The evidence does not reflect, and the Veteran does not contend that he has ever been prescribed bed rest by a physician at any point prior to January 23, 2009. The January 2009 VA examiner indicated that the Veteran has had 12 episodes of incapacitating episodes of the cervical spine, with each episode lasting one day, representing a total of 12 days of incapacitating episodes. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent disability evaluation is contemplated for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent disability evaluation is assigned for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent disability evaluation is assigned for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent disability evaluation is assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. Thus, prior to June 29, 2007, and from June 29, 2007 to January 22, 2009, there is no evidence or allegation of any incapacitating episodes whatsoever, and a higher rating is not warranted on this basis. For the period of time beginning January 23, 2009, the Veteran cannot receive a higher rating for his cervical sprain/strain with herniated discs based upon incapacitating episodes because, assuming the evidence for this time period showing incapacitating episodes having a duration of 12 days during the past 12 months is credible, only a 10 percent rating is warranted for such a duration. Therefore, because the Veteran is already in receipt of a 20 percent rating during this time period, a higher rating is not warranted. In conclusion, the Veteran cannot receive a higher rating on this basis at any point during the appeal period. Under the General Rating Formula for Diseases and Injuries of the Spine, Note (1) specifies that any associated objective neurologic abnormalities, to include radiculopathy, should be separately evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). A review of the evidence does not reflect any neurological complaints or findings related to the Veteran's cervical sprain/strain with herniated discs. Specifically, the Veteran's upper extremity strength was full in May 2008, and near full (4+/5) in January and September 2009. Moreover, there has never been any atrophy, and sensory examination of the upper extremities has consistently been normal throughout the initial evaluation period. Although the September 2009 VA examination report reflects that the Veteran reported a history of weakness or paralysis of the upper extremities, the objective medical evidence does not confirm such a history and the VA examiner indicated that the Veteran had no history of paresthesias, numbness, poor coordination, or other neurological symptoms. The evidence also does not reflect any bowel or bladder impairment. Therefore, there is no evidence of neurological impairment at any time throughout the initial evaluation period. As such, a separate rating for neurological impairment is not warranted for any time period on appeal. In sum, the Board notes that there is no indication in the medical evidence of record that the Veteran's cervical sprain/strain warrants a higher rating than the currently assigned noncompensable rating prior to June 29, 2007, the 10 percent rating assigned from June 29, 2007 to January 22, 2009, and the 20 percent rating assigned from January 23, 2009. See Fenderson, 12 Vet. App. 119, 126 (1999). The preponderance of the evidence is against the Veteran's claims for increase. There is no doubt to be resolved, and a higher initial rating for cervical sprain/strain with herniated discs is not warranted for any time during the initial evaluation period. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In reaching this conclusion, the Board acknowledges the Veteran's belief that his cervical sprain/strain with herniated discs is more severe than the current disability evaluations reflect. In this regard, the Board must consider the entire evidence of record when analyzing the criteria set forth in the ratings schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology and the Board has addressed the Veteran's reported symptoms, the Board finds that the medical evidence of record is more persuasive regarding whether he is entitled to a higher disability rating in accordance with the schedular criteria. The VA examiners considered the Veteran's reported symptoms and provided the clinical findings to rate the Veteran's cervical sprain/strain with respect to the rating criteria. Therefore, the Board finds that the medical evidence is more persuasive than the Veteran's own statements regarding his increased cervical spine symptomatology. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). II. Lumbar Sprain/Strain with Herniated Discs The medical evidence of record includes a March 2007 private treatment record which notes that the Veteran has degenerative arthritic changes in the lumbar spine. An April 2007 VA examination report notes that the Veteran's lumbar sprain/strain has no significant effects on the Veteran's usual occupation. It has a moderate effect on sports, a mild effect on chores, exercise, and recreation, and no effect on shopping, traveling, feeding, and bathing. Range of motion testing of the lumbar spine revealed painless passive and active forward flexion from zero to 90 degrees, painless passive and active forward extension from zero to 30 degrees, active left and right lateral flexion from zero to 30 degrees, painless passive and active left and right rotation from zero to 30 degrees. The examiner opined that there was no additional limitation of range of motion or joint function due to pain, fatigue, weakness, lack of endurance, or following repetitive use or during flare-ups. In his February 2008 notice of disagreement, the veteran indicated that due to his lumbar sprain/strain, he has trouble bending to tie his shoes, getting in and out of a car, and cannot exercise or lift. He also indicated that he could not perform his employment duties working in a VA Medical Center kitchen due to his back problems. In an April 2008 statement the Veteran indicated that he had worked as a corrections sergeant after service, but he was unable to respond to emergency situations as fast as he should have been and the mandatory bulletproof vest that he wore hurt his back. An October 2008VA treatment record indicates that the Veteran has complaints of low back pain with no radicular symptoms and no loss of bowel or bladder control. An October 2008 X-ray study reveals an impression of mild, multilevel degenerative change of the lumbar spine. A January 2009 VA examination report notes that the Veteran has no history of urinary or fecal incontinence, numbness, paresthesias or falls. There is a history of leg or foot weakness and unsteadiness, fatigue, decreased motion , stiffness, weakness, spasms, and pain. The Veteran described the pain as sharp, moderate, constant and daily. It occurs in the lumbar spine and radiates to the right lower extremity. He complained of severe flare-ups that occur weekly and last hours. Flare-ups are brought on by getting in and out of the car and driving, and are relieved by time. The Veteran estimated that he loses an additional 50 percent of motion or other functional impairment during flare-ups. It was noted that there are incapacitating episodes of the thoracolumbar spine. The examiner stated that this occurred 12 times and he stayed in bed one day each time during the past 12-month period. It was noted that the Veteran uses a cane and is able to walk one quarter of a mile. There is no ankylosis of the thoracolumbar spine. On examination there was no spasm, atrophy, guarding, pain with motion, tenderness, or weakness. There was no muscle spasm, localized tenderness or guarding severe enough to be responsible for abnormal gait or abnormal spinal contour. Motor examination of the lower extremities was full and sensory examination was normal. Reflexes were normal. Range of motion testing revealed active flexion from zero to 30 degrees, extension from zero to 20 degrees, left lateral flexion to 25 degrees, right lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. There was no objective evidence of pain on active range of motion. Further, the examiner found that there was no objective evidence of pain following repetitive motion and there was no additional limitation after three repetitions. Lasegue's sign was negative. The examiner opined that the Veteran's subjective complaints correlate with physical findings. The examiner also noted that DeLuca was positive. An April 2009 VA treatment record notes that the Veteran complained that his low back was 10 out of 10 in terms of severity. Flexion of the lumbar spine was to 10 degrees, extension was to 10 degrees, right and left lateral rotation was to 10 degrees and right and left lateral flexion was to 15 degrees. There were muscle spasms at the right lumbar paraspinals. Another April 2009 VA treatment record notes that the low back had slight to moderate limitation in range of motion. Another April 2009 VA treatment record notes that lumbar range of motion was moderately decreased in terms of flexion, extension, and bilateral side bending. There was no palpatory tenderness in the lumbar paraspinals. Motor strength testing was near full. Sensory examination was normal. The diagnosis was lumbar spondylosis and degenerative disc disease. A May 2009 VA treatment record reflects that the Veteran was seen for right low back pain. He stated that o couple of times a week he gets spasms in the back. His pain level in the lumbar spine was described as 8 out of 10. Pain gets worse with repetitive up and down, waking in the morning, and driving distances. He denied radiation of pain, numbness, tingling, saddle anesthesia, and bowel or bladder incontinence. The assessment was degeneration of lumbosacral intervertebral discs and chronic low back pain. A September 2009 VA examination report notes that there is no urinary or fecal incontinence. The examiner noted that the examination was for intervertebral disc syndrome, but there were no incapacitating episodes during the past 12-month period. It was noted that the Veteran's gait was normal. Lower extremity motor and reflex examination was normal bilaterally. There was no evidence of sensory loss. The examiner opined that the Veteran's back injuries have no effect on usual daily activities. EMG/NCV study revealed mild/chronic distal peroneal motor neuropathy of the right foot, likely compatible with old traumatic injury to right ankle. No other neurological diagnosis was rendered. Examination of the spine revealed normal posture, head position, symmetry, and gait. There were no abnormal spinal curvatures such as gibbus, kyphosis, list, lumbar flattening, lumbar lordosis, scoliosis, reverse lordosis, or thoracolumbar spine ankylosis. There was no spasm, atrophy, guarding, pain with motion or weakness. There was tenderness of the thoracic sacrospinalis. Motor strength testing of the lower extremities was normal. Sensory examination was normal, as was muscle tone. There was no muscle atrophy. Lasegue's sign was negative. Wadell's sign was positive for lower back pain with one pound axial loading. The examiner opined that exaggeration of the Veteran's decreased lumbar spine range of motion testing with the goniometer was appreciated because more movement was observed during the interview period. The estimated range of motion of the lumbar spine was flexion to 60 degrees, left lateral rotation of 40 degrees and right lateral rotation of 30 percent. X-ray studies of the lumbar spine revealed stable mild degenerative changes. The examiner opined that the Veteran's lumbar spine disability has a moderate effect on chores, exercise, sports, recreation, traveling. It has a mild effect on shopping and no effect on feeding, bathing, dressing, toileting, and grooming. The VA examiner opined that the Veteran's back problems can affect his ability to perform physical employment. An August 2010 VA treatment record notes the Veteran's complaints of low back pain. On examination there was tenderness in the low back. Based upon the evidence of record for the time period prior to January 23, 2009, a compensable rating based upon limitation of motion is not warranted for the Veteran's lumbar sprain/strain with herniated discs. Initially, the Board notes that at the April 2007 VA examination, flexion of the thoracolumbar spine was to a full 90 degrees without pain. Therefore, forward flexion of the thoracolumbar spine was greater than 85 degrees, and a higher rating is not available on that basis. Additionally, the combined range of motion of the thoracolumbar spine was greater than 235 degrees. Notably, at the April 2007 VA examination, the combined range of motion was 240 degrees without pain. Therefore, a higher rating is not warranted on that basis. Moreover, the evidence for this time period does not show muscle spasm, guarding, localized pain, or vertebral body fracture with loss of 50 percent or more of the height. Therefore, a compensable rating is not warranted based upon limitation of motion for the time period prior to January 23, 2009. A higher rating based upon limitation of motion is also not warranted for the time period beginning on January 23, 2009. As neither unfavorable ankylosis of the entire spine nor unfavorable ankylosis of the entire thoracolumbar spine has been shown during the time period beginning on January 23, 2009, an initial rating greater than 40 percent is not warranted under the General Rating Formula. In this regard, the Board notes that the Veteran retains some useful motion (albeit limited) of his thoracolumbar spine during this time period. Moreover, the September 2009 VA examiner specifically stated that there was no thoracolumbar spine ankylosis. As such, ankylosis is not present. Consequently, a rating in excess of 40 percent is not warranted based upon limitation of motion for the time period from January 23, 2009. The evidence of record also does not show that the Veteran's lumbar sprain/strain with herniated discs causes a level of functional loss greater than that already contemplated by the assigned noncompensable rating prior to January 23, 2009 or the 40 percent rating beginning on January 23, 2009. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). During the time period prior to January 23, 2009, the evidence reflects that the Veteran experienced no pain during forward flexion and other ranges of motion of the thoracolumbar spine. Moreover, the April 2007 VA examiner opined that there was no additional limitation of range of motion or joint function due to pain, fatigue, weakness, lack of endurance or following repetitive use or during flare-ups. Although there is evidence of reduced and painful motion beginning on January 23, 2009, and the January 2009 VA examiner found that DeLuca factors were positive, the January 2009 VA examiner also found that there was no additional loss of motion on repetitive use. With respect to the Veteran's January 2009 statement that his flare-ups cause a 50 percent reduction in range of motion, the Board finds that any additional loss of motion due to pain, fatigue, weakness, lack of endurance, or incoordination during such flare-ups does actually not result in unfavorable ankylosis of the thoracolumbar spine or the entire spine. Notably, even after three repetitions in January 2009, range of motion of the thoracolumbar spine did not decrease even one degree. As such, the Board acknowledges that the Veteran's loss of motion/functional loss certainly will increase during a flare-up, but the objective evidence of record does not demonstrate that flexion more nearly approximates unfavorable ankylosis of the entire thoracolumbar spine or the entire spine during such a flare-up. In this regard, the Board finds that if there was such a drastic loss of range of motion during such a flare-up (i.e., a 50 percent loss), there would be some correlation in terms of some degrees of range of motion lost on examination after three repetitions. Because there was absolutely no loss of motion demonstrated on examination after three repetitions in January 2009, the Board finds that although range of motion/functional loss during a flare-up exists, it does not amount to a loss more nearly approximating unfavorable ankylosis of the thoracolumbar spine or the entire spine. The Board finds this to be true especially given the September 2009 VA examiner's finding of exaggeration appreciated regarding the decreased range of motion exhibited during goniometer testing. Instead, the evidence tends to show that any additional loss of motion due to flare-ups or repetitive use is contemplated by the currently assigned noncompensable rating prior to January 23, 2009 and the 40 percent rating beginning January 23, 2009. See id.; see also 38 C.F.R. § 4.71a, General Rating Formula; Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In sum, the record does not establish the existence of functional loss for the purposes of 38 C.F.R. §§ 4.40 and 4.45 beyond that contemplated in the currently assigned ratings for the appropriate time periods. The provisions of 38 C.F.R. § 4.71a indicate that intervertebral disc syndrome should be evaluated under the General Rating Formula or under the Formula for Rating Intervertebral Disc Syndrome, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. The evidence does not reflect that the Veteran has ever been prescribed bed rest by a physician at any point prior to January 23, 2009. The January 2009 VA examiner indicated that the Veteran has had 12 episodes of incapacitating episodes of the lumbar spine, with each episode lasting one day, representing a total of 12 days of incapacitating episodes. As previously noted, a period of 12 days of incapacitating episodes is less than two weeks. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent disability evaluation is contemplated for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. Thus, the Veteran cannot receive a higher rating for his lumbar sprain/strain with herniated discs based upon incapacitating episodes at any point during the appeal period. Under the General Rating Formula for Diseases and Injuries of the Spine, Note (1) specifies that any associated objective neurologic abnormalities, to include radiculopathy, should be separately evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). A review of the evidence does not reflect any related neurological complaints or findings. Specifically, the October 2008 VA treatment record indicates that the Veteran had no radicular symptoms, weakness, or bowel or bladder involvement. In addition, sensory examination has consistently been normal. Reflexes were normal in January 2009, and motor strength was normal in April 2009 and September 2009. Further, the evidence consistently shows no atrophy. (Although there is evidence of a mild chronic distal peroneal motor neuropathy of the right foot, this was not found to be related to the service-connected lumbar sprain/strain. In any event, service connection for this disability was granted in a May 2009 rating decision.) Therefore, there is no evidence of neurological impairment related to the lumbar sprain/strain with herniated discs at any time throughout the initial evaluation period. As such, a separate rating for neurological impairment is not warranted for any time period. In sum, the Board notes that there is no indication in the medical evidence of record that the Veteran's lumbar sprain/strain warrants a higher rating than the currently assigned noncompensable rating prior to January 23, 2009 and the 40 percent rating assigned from January 23, 2009. See Fenderson, 12 Vet. App. 119, 126 (1999). The preponderance of the evidence is against the Veteran's claims for increase. There is no doubt to be resolved, and a higher initial rating for lumbar sprain/strain is not warranted for any time during the initial evaluation period. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In reaching this conclusion, the Board acknowledges the Veteran's belief that his lumbar sprain/strain with herniated discs is more severe than the current disability evaluations reflect. In this regard, the Board must consider the entire evidence of record when analyzing the criteria set forth in the ratings schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology and the Board has addressed the Veteran's reported symptoms, the Board finds that the medical evidence of record is more persuasive regarding whether he is entitled to a higher disability rating in accordance with the schedular criteria. The VA examiners considered the Veteran's reported symptoms and provided the clinical findings to rate the Veteran's lumbar sprain/strain with respect to the rating criteria. Therefore, the Board finds that the medical evidence is more persuasive than the Veteran's own statements regarding his increased lumbar spine symptomatology. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). III. Extraschedular consideration With respect to the Veteran's claims for increased ratings for cervical and lumbar sprain/strain with herniated discs, the Board notes that an exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, then the Board must consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Id. at 115-116. When those two elements are met, the appeal must be referred for consideration of the assignment of an extraschedular rating to the Chief Benefits Director or the Director, Compensation and Pension Service, for consideration of an extraschedular evaluation. 38 C.F.R. § 3.321(b) (1) (2012). Otherwise, the schedular evaluation is adequate, and referral is not required. Thun, 22 Vet. App. at 116. The Board finds that the diagnostic criteria adequately describe the severity and symptomatology of the Veteran's service-connected cervical and lumbar sprain/strain with herniated discs. There are higher schedular ratings available under the appropriate diagnostic codes, but for manifestations of spine disabilities which are not present in this case. The Board recognizes that the Veteran has pain and loss of motion, but such manifestations are accounted for by the assigned ratings for the appropriate time periods. As such, no further analysis is required, and referral for extraschedular evaluation is not warranted. IV. SMC SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated as 100 percent and, in addition: (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C.A. § 1114(s) ; 38 C.F.R. § 3.350(i). A TDIU 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. C.F.R. § 4.16(a). The Board notes that VA has a well-established duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement special monthly compensation (SMC) under 38 U.S.C.A § 1114. See Bradley v. Peake, 22 Vet. App. 280 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim" and remanding, pursuant to VA's duty to maximize benefits, for VA to determine whether the Veteran's posttraumatic stress disorder, rated 70 percent disabling, would entitle him to a TDIU and, therefore, to SMC). Subsection 1114(s) requires that a disabled Veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114(s) benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. The Court has held that although a TDIU may satisfy the "rated as total" element of section 1114(s), a TDIU based on multiple underlying disabilities cannot satisfy the section 1114(s) requirement of "a service-connected disability" because that requirement must be met by a single disability. The Court declared, however, if a Veteran were awarded a TDIU based on multiple underlying disabilities and then later receives a schedular disability rating for a single, separate disability that would, by itself, create the basis for an award of a TDIU, that the order of the awards was not relevant to the inquiry as to whether any of the disabilities alone would render the Veteran unemployable and thus entitled to a TDIU rating based on that condition alone. Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). In this case, in the November 2011 Board decision and through a separate Corrective Order, the Board has granted a TDIU as of February 12, 2008. The evidence reflects that the TDIU is warranted for that time period solely due to PTSD, as the evidence shows this disability is of sufficient severity to alone produce unemployability. [Notably, the Veteran's service-connected disabilities as of February 12, 2008, are PTSD, rated at 30 percent; TBI, rated at 40 percent; headaches, rated at 30 percent; cervical sprain/strain with herniated discs, rated at 10 percent; lumbar sprain/strain with herniated discs, rated as noncompensable; and degenerative changes and subluxation of the left acromioclavicular joint of the left shoulder, rated at 10 percent. The combined rating is 80 percent. As such, the Veteran met the minimum schedular requirement for a TDIU as of February 12, 2008. With regard to whether the Veteran was unemployable during this time, the December 2009 VA examiner concluded that the Veteran was unemployable on the basis of his PTSD alone. The examiner cited to multiple PTSD symptoms that were sufficient to preclude him from gainful employment. The Board, in the November 2011 decision, found that although the December 2009 VA examiner's opinion was rendered more than three years after service separation, the overall evidence of record, including the Veteran's credible self-reported symptoms, reflects that the symptoms the December 2009 VA examiner cited were present since at least May 23, 2006. As such, the Board finds that a TDIU is warranted based upon the Veteran's PTSD alone for the time period beginning on February 12, 2008.] Because the Veteran has a single service-connected disability rated as total (i.e., PTSD) as of February 12, 2008, and has additional service-connected disabilities that are rated at 60 percent combined as of February 12, 2008, the criteria for SMC at the housebound rate are met as of February 12, 2008. [For this time period the Veteran's other service-connected disabilities are TBI, rated at 40 percent; headaches, rated at 30 percent; cervical sprain/strain with herniated discs, rated at 10 percent; lumbar sprain/strain with herniated discs, rated as noncompensable; and degenerative changes and subluxation of the left acromioclavicular joint of the left shoulder, rated at 10 percent. The combined rating is 70 percent.] Thus, in light of the Court's decisions in Bradley and in Buie, entitlement to SMC at the housebound rate under 38 U.S.C.A. § 1114(s) is granted, effective February 12, 2008. [The Board recognizes that the Veteran is already in receipt of SMC for the time period from December 30, 2008 but prior to March 1, 2009.] ORDER Entitlement to an initial compensable rating for cervical sprain/strain with herniated discs prior to June 29, 2007 is denied. Entitlement to an initial rating in excess of 10 percent for cervical sprain/strain with herniated discs from June 29, 2007 to January 22, 2009 is denied. Entitlement to an initial rating greater than 20 percent for cervical sprain/strain with herniated discs beginning January 23, 2009 is denied. Entitlement to an initial compensable rating for lumbar sprain/strain with herniated discs prior to January 23, 2009 is denied. Entitlement to an initial rating greater than 40 percent for lumbar sprain/strain with herniated discs beginning January 23, 2009 is denied. Entitlement to SMC pursuant to 38 U.S.C.A. § 1114(s) beginning on February 12, 2008 (except for the time period from December 30, 2008 to February 28, 2009, during which SMC has been granted) is granted, subject to the criteria governing the payment of monetary benefits. REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's remaining claims so that he is afforded every possible consideration. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. A review of the record reveals that prior to February 12, 2008, the Veteran's service-connected disabilities included, PTSD, rated at 30 percent; lumbar sprain/strain with herniated discs, rated as noncompensable; cervical sprain/strain, rated as noncompensable; degenerative changes and subluxation of the left acromioclavicular joint of the left shoulder, rated as 10 percent disabling; and right peroneal motor neuropathy, rated as noncompensable. Because the combined evaluation for these service-connected disabilities for the time period from May 23, 2006 to February 11, 2008 was only 40 percent, the minimum schedular requirement for a TDIU was not met and as such, the Board is not entitled to award a TDIU in the first instance. Therefore, this issue is remanded to the RO for consideration of TDIU on an extraschedular basis pursuant to 38 C.F.R. § 4.16(b). The issue of entitlement to SMC based upon housebound status prior to February 12, 2008 is inextricably intertwined with the issues of entitlement to a TDIU prior to February 12, 2008, and both issues are inextricably intertwined with several of the issues that the Board remanded in November 2011, development and readjudication of which have not yet been accomplished. (These issues include entitlement to service connection for residuals of lateral right thigh and calf skin graft claimed as scar, entitlement to service connection for a skin condition, entitlement to service connection for a nasal/nose disability to include on a secondary basis, entitlement to service connection for a sleep disorder, to include on a secondary basis, entitlement to service connection for residuals of a tonsillectomy to include on a secondary basis, entitlement to a rating greater than 30 percent for PTSD prior to February 21, 2008.) See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a "significant impact" upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Therefore, the claims are remanded pending adjudication of the inextricably intertwined issues. Moreover, the Veteran has not received proper notice in connection with his March 2011 claim for SMC based upon housebound status. As such, proper notice should be sent. Finally, if, after the inextricably intertwined issues are adjudicated, it is determined that the Veteran does not meet the disability rating percentage criteria set forth for SMC pursuant to 38 U.S.C.A. § 1114(s) prior to February 12, 2008, an examination should be scheduled in order to determine whether the Veteran is substantially confined as a direct result of service-connected disability to his dwelling and the immediate premises. See 38 C.F.R. § 3.350 (2012). Accordingly, the case is REMANDED for the following action: 1. Issue a VCAA notice letter on the issue of entitlement to SMC pursuant to 38 U.S.C.A. § 1114(s) in accordance with 38 U.S.C.A. §§ 5102, 5103, and 5103A (West 2002 & Supp. 2012), 38 C.F.R. § 3.159 (2012), and applicable legal precedent. 2. Forward the Veteran's claims file to the Director, Compensation and Pension Service, for consideration of entitlement to a TDIU prior to February 12, 2008 pursuant to 38 C.F.R. §4.16(b). 3. If, and only if, after developing and adjudicating the claims which were remanded by the Board in November 2011, it is determined that for the time period prior to February 12, 2008, the Veteran does not have a disability rated at 100 percent and additional disability independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, the Veteran should be scheduled for VA examination by an appropriate VA examiner in order to determine whether the Veteran is permanently housebound (substantially confined as a direct result of service-connected disability/disabilities to his dwelling and the immediate premises) by reason of service-connected disability or disabilities. The examiner should provide a rationale for the opinion given. 4. After undertaking the development above, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, issue a Supplemental Statement of the Case to the Veteran and his representative. Give the Veteran and his representative an appropriate period of time in which to respond. Then, return the appeal to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs