Citation Nr: 18140176 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-39 947 DATE: October 2, 2018 ORDER Entitlement to a rating in excess of 10 percent for a lumbosacral strain prior to November 30, 2016 is denied. Entitlement to a 40 percent evaluation for degenerative arthritis of the lumbar spine status post spinal fusion from November 30, 2016 is granted. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is denied Entitlement to an initial rating in excess of 10 percent for a right forearm condition with painful motion prior to December 21, 2016 is denied. Entitlement to a rating in excess of 20 percent for a right forearm condition with painful motion from December 21, 2016 is denied. Entitlement to an initial 10 percent rating for a right forearm condition with limitation of extension is granted. Entitlement to an effective date prior to December 21, 2016, for the grant of service connection for a right forearm condition with limitation of extension is denied. Entitlement to a temporary total rating under the provisions of 38 C.F.R. § 4.30 based on the need for convalescence following lumbar spine surgery is denied. REMANDED Entitlement to an effective date prior to November 30, 2016 for the grant of a total disability rating on the basis of individual unemployability due to service-connected disabilities (TDIU) is denied. Entitlement to an effective prior to November 30, 2016 for eligibility to Dependents’ Educational Assistance under 38 U.S.C. Chapter 35 is denied. FINDINGS OF FACT 1. For the period prior to November 30, 2016, the Veteran’s lumbar spine condition was manifested by forward flexion of no less than 0 to 70 degrees, combined range of motion of the thoracolumbar spine of no less than 150 degrees, and no abnormal gait, spinal contour, or ankylosis; furthermore, the Veteran’s condition did not require doctor-prescribed bed rest at any during this period. 2. From November 30, 2016, the Veteran’s lumbar spine condition was manifested by forward flexion of 35 degrees, but with evidence of functional loss associated with motion and pain with weight bearing. 3. For the entire period of the appeal, the Veteran’s right lower extremity radiculopathy was manifested by mild, incomplete paralysis of the sciatic nerve of an entirely sensory nature. 4. For the entire period of the appeal, the Veteran’s left lower extremity radiculopathy was manifested by mild, incomplete paralysis of the sciatic nerve of an entirely sensory nature. 5. The Veteran is right-hand dominant. 6. For the period prior to December 21, 2016, the Veteran’s right forearm condition manifested in painful flexion and supination; however, the right forearm condition was not characterized by flexion limited to 100 degrees or less, bone fusion, or limitation of pronation beyond last quarter of arc. 7. For the period from December 21, 2016, the Veteran’s right forearm condition manifested in limitation of pronation beyond last quarter of arc. 8. For the entire period of the appeal, the Veteran’s right forearm condition did not manifest in extension limited to 45 degrees or more, but was actually painful. 9. The Veteran’s right forearm condition was evaluated pursuant to the Board of Veterans’ Appeals’ October 2016 Remand instructions; as such, he did not file any claim for increased rating of the condition. 10. A factually ascertainable increase in disability of the right forearm condition, to include the manifestation of limited extension, was not shown to have occurred prior to the December 21, 2016 VA examination. 11. The Veteran was hospitalized for 2 days following his May 2014 lumbar spine surgery; the Veteran’s treatment for the surgery did not require at least one month of convalescence, and did not result in severe post-operative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited), or immobilization by cast, without surgery, of one major joint or more. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to November 30, 2016 for a lumbar spine condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5242. 2. The criteria for entitlement to a 40 percent rating from November 30, 2016 for a lumbar spine condition have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5242. 3. The criteria for entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8720. 4. The criteria for entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8720. 5. Prior to December 20, 2016, the criteria for an initial rating in excess of 10 percent for painful flexion of the right forearm have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5206-5213. 6. From December 20, 2016, the criteria for a rating in excess of 20 percent for painful flexion of the right forearm have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5213. 7. The criteria for entitlement to an initial 10 percent rating for limited extension of the right forearm have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5207. 8. The criteria for an effective date earlier than December 21, 2016 for the grant of a noncompensable initial rating for right forearm limitation of extension have not been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.400, 4.7, 4.115b, Diagnostic Code 5207. 9. The criteria for a temporary total rating under 38 C.F.R. §§ 4.29 and 4.30 for hospitalization in excess of 21 days and treatment requiring convalescence for the May 2014 lumbar spine surgery are not met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.29, 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1989 to November 1992. This case was last before the Board in October 2016, whereupon certain matters were remanded to the RO for further development. During that development the RO issued a January 2017 rating decision granting entitlement to additional benefits not previously before the Board. Following the Veteran’s submission of a notice of disagreement as to the newly granted benefits as well as an appeal of the RO’s decision with regards to those issues on remand from the Board, the RO promulgated October 2017 Statements of the Case as well as a November 2017 Supplemental Statement of the Case. Thereafter, all of these issues were returned to the Board for its adjudication. The Veteran testified at a September 2016 videoconference hearing before the undersigned Veterans Law Judge; a copy of the transcript of that proceeding is of record. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple (“staged”) ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. In determining the appropriate rating for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Factors of joint disability include increased or limited motion, weakened movement, excess fatigability, incoordination, and painful movement, including during flare-ups and after repeated use. DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995); 38 C.F.R. § 4.45. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Pain in a particular joint may result in functional loss, but only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance. Id.; 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.59, painful joints are entitled to at least the minimum compensable rating for the joint. 1. Entitlement to an increased rating for a lumbar spine condition. The Veteran is service connected for a lumbar spine condition. Prior to November 30, 2016, the condition is characterized as a lumbosacral strain, and is assigned a 10 percent rating. From November 30, 2016, the condition is characterized as degenerative arthritis of the lumbar spine with intervertebral disc syndrome status post spinal fusion, and is assigned a 20 percent rating. The Veteran seeks an increased rating of the condition for the entire period of the appeal. Spinal conditions are evaluated under either the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Formula for Rating IVDS), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. §§ 4.25, 4.71a, Diagnostic Codes, 5242. The General Rating Formula provides for a 10 percent evaluation for 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. A 20 percent rating is for application with 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 assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243). For VA compensation purposes, 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 thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, General Rating Formula, Note (2); see also 38 C.F.R. § 4.71a, Plate V. According to the Formula for Rating IVDS, a 10 percent rating is warranted for incapacitating episodes having a total during of at least one week but less than two weeks during the past 12 months; a 20 percent rating requires evidence of incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past twelve months; a 40 percent rating requires evidence of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating requires evidence of incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS. An “incapacitating episode” is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). If IVDS is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment will be evaluated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. Id. at Note (2). Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that a rating in excess of 10 percent is warranted for the Veteran’s lumbar spine condition prior to November 30, 2016, the date of the most recent VA spine examination. During the appeal period and prior to this most recent examination, the Veteran was afforded a VA examination dated in April 2016, which did not reveal symptomatology that warranted a rating in excess of 10 percent. Specifically, range of motion testing showed forward flexion of 70 degrees, and a combined range of motion of the thoracolumbar spine greater than 120 degrees. Moreover, the Veteran did not report experiencing incapacitating episodes required doctor-prescribed bed rest in the 12 months preceding the examination. It was the examiner’s opinion that the lumbar spine condition had no impact on the Veteran’s ability to work, although the Board acknowledges that the Veteran reported that he experienced flare-ups of symptoms during which he could not bend over. The Board has reviewed the lay testimony of record as well as the VA and private medical records in the claims file, but this evidence does not tend to show that the symptoms of his lumbar spine condition warranted a rating in excess of 10 percent prior to November 30, 2016. Specifically, treatment records from St. Luke’s Orthopedic Specialists and Valley Medical Center dating from up to a year prior to the filing of his claim do not show that the Veteran reported experiencing any symptomatology related to his lumbar spine other than pain and stiffness. The Veteran submitted statements from his wife and family in which they attested to his reduced ability to carry out physical activities, and he also stated during the September 2016 hearing that he was experiencing significant pain and difficulty with physical activities; however, this lay testimony reflects only that the Veteran experienced pain associated with his lumbar spine condition, and not any of the symptomatology that would warrant a higher rating. The 10 percent rating for the period prior to November 30, 2016 was granted with consideration of the functional loss stemming from the Veteran’s symptoms of pain and weakness. As stated, for the additional functional loss to warrant a higher rating, that loss must rise to the level of the more restricted forward flexion necessary for entitlement to the next degree of disability, or incapacitating episodes requiring doctor-prescribed bed rest, neither of which has been shown. Therefore, the Board finds that the assigned rating for the period prior to November 30, 2016 adequately contemplates the functional impairment resulting from the Veteran’s lumbar spine condition. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 208. As for the period from November 30, 2016, the Board finds a basis for a 40 percent rating. The increase to 20 percent was predicated on forward flexion to 35 degrees shown by the VA examination from that date. Notably, the examiner confirmed both functional loss that range of motion contributed to, and pain with weight bearing. Keeping in mind the provisions of 38 C.F.R. §§ 4.40 and 4.45 and Correia v. McDonald, 28 Vet. App. 158 (2016), which addresses weight bearing among other orthopedic matters, the Board finds that the actual disability picture is commensurate to limitation of flexion to 30 degrees or less when all functional loss and pain factors are considered. This provides a basis for a 40 percent evaluation as of November 30, 2016. That said, there is no basis for an even higher evaluation. On the same examination, no ankylosis was reported. Moreover, while the examiner also acknowledged that the Veteran experienced intervertebral disc syndrome, they noted that the Veteran did not require doctor-prescribed bedrest in the 12 months preceding the examination. In the absence of a basis for an even higher evaluation, a 40 percent rating, but no higher, is warranted as of November 30, 2016. To this extent, the appeal is granted. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, other than the earlier effective date claims which are addressed and granted in part below. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). 2. Entitlement to increased initial ratings for bilateral lower extremity radiculopathy The Veteran is service connected for right and left lower extremity radiculopathy, each assigned an initial 10 percent rating from November 30, 2016. He seeks an increased rating for the entire period of the appeal. The ratings for the right and left lower extremity radiculopathy were assigned pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8720, which corresponds to neuralgia of the sciatic nerve. Under Diagnostic Code 8720, a 10 percent rating is warranted for incomplete neuralgia of mild severity, while a 20 percent rating is warranted for moderate severity and a 40 percent rating is warranted for incomplete neuralgia that is moderately severe in nature. In defining the distinction between the 20 and 40 percent rating, 38 C.F.R. § 4.124a provides that the rating should be either for the mild or at most the moderate degree if the involvement of the nerves is wholly sensory. The 10 percent rating was assigned based on the November 30, 2016 spine examination, wherein the examiner diagnosed the Veteran with bilateral lower extremity radiculopathy and evaluated both the right and left conditions as being mild in severity. A review of VA and private medical records does not reflect that the Veteran has ever reported experiencing any radicular symptomatology that is more than sensory in nature. Moreover, the Veteran did not mention any radicular symptoms during the September 2016 hearing, and none of the other lay testimony in the record reflects that the Veteran had ever reported experiencing any radicular symptoms to his wife or family. While the wholly sensory nature of the Veteran’s bilateral lower extremity radicular symptoms does not automatically preclude an increase to 20 percent bilaterally, there is no evidence in the claims file to refute the November 2016 VA examiner’s evaluation of the bilateral radiculopathy being no more than mild in severity. Therefore, in light of the VA examiner’s evaluation and the lack of any additional evidence to suggest that the radicular symptoms are any more than mild in severity, the Board finds that an initial rating in excess of the currently assigned 10 percent for both right and left lower extremity radiculopathy is not warranted. 3. Entitlement to an increased rating for a right forearm condition with painful motion as well as limitation of extension The Veteran is in receipt of a 10 percent initial rating for a right forearm condition manifested with painful motion prior to December 21, 2016, and a 20 percent initial rating therefrom. He is also in receipt of a noncompensable initial rating for the limitation of extension that he experiences in his right forearm. He seeks an increased rating for both conditions for the entire period of the appeal. Limitation of elbow motion is rated under Diagnostic Codes 5206, 5207, 5208, and 5213. The initial ratings for painful motion of the right forearm were assigned pursuant to Diagnostic Code 5213, while the initial noncompensable rating for the limitation of extension was assigned pursuant to Diagnostic Code 5207. Diagnostic Code 5206 provides for ratings of 0, 10, 20, 20, 30, or 40 percent where there is limitation of flexion of the minor forearm to 110, 100, 90, 70, 55, or 45 degrees, respectively. Ratings of 0, 10, 20, 30, 40, or 50 are warranted where there is limitation of flexion of the major forearm to 110, 100, 90, 70, 55, or 45 degrees, respectively. 38 C.F.R. § 4.71a. Diagnostic Code 5207 provides for ratings of 10, 10, 20, 20, 30, or 40 percent for limitation of extension of the minor forearm to 45, 60, 75, 90, 100, or 110 degrees, respectively. Ratings of 10, 10, 20, 30, 40, or 50 percent are warranted for limitation of extension of the major forearm to 45, 60, 75, 90, 100, or 110 degrees, respectively. 38 C.F.R. § 4.71a. Under Diagnostic Code 5208, a 20 percent rating is warranted for flexion limited to 100 degrees and extension limited to 45 degrees. Id. This is the only rating available under Diagnostic Code 5208. Diagnostic Code 5213, applicable to impairment of supination and pronation, provides for a rating of 10 percent for limitation of supination to 30 degrees or less for the major or minor arm. A 20 percent rating is warranted both the major and minor arms for limitation of pronation with motion lost beyond last quarter of arc, where the hand does not approach full pronation. For limitation of pronation with motion lost beyond middle of arc, a 30 percent rating is warranted for the major arm and a 20 percent rating is warranted for the minor arm. For loss of supination and pronation (bone fusion) with the hand fixed near the middle of the arc or moderate pronation, a 20 percent rating is warranted for the major and minor arms. For loss of supination and pronation (bone fusion) with the hand fixed in full pronation, a 30 percent rating is warranted for the major arm and a 20 percent rating is warranted for the minor arm. For loss of supination and pronation (bone fusion) with the hand fixed in supination or hyperpronation, a 40 percent rating is warranted for the major arm and a 30 percent rating is warranted for the minor arm. Id. In all the forearm and wrist injuries, Diagnostic Codes 5205 through 5213, multiple impaired finger movements due to tendon tie-up, muscle injury, or nerve injury, are to be separately rated and combined, not to exceed the rating for loss of use of the hand. 38 C.F.R. § 4.71a, Note. For VA compensation purposes, normal flexion and extension of the elbow is from 0 degrees of extension to 145 degrees of flexion, pronation is from 0 to 80 degrees, and normal supination is from 0 to 85 degrees. 38 C.F.R. § 4.71, Plate I. As an initial matter, the Veteran is right hand dominant. See April 2016 VA elbow and forearms conditions examination report. Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that an initial rating in excess of 10 percent is warranted for painful motion of the right forearm prior to December 21, 2016, the date of the most recent VA arm examination. During the appeal period and prior to this most recent examination, the Veteran was afforded a VA examination dated in April 2016, which did not reveal symptomatology that warranted a rating in excess of 10 percent. Specifically, range of motion testing showed flexion and extension of 130 degrees, while supination was 60 degrees and pronation was 80 degrees. Pain was noted on examination, but it did not cause functional loss. No pain with weight bearing or crepitus was detailed; however, the examiner did acknowledge that there was evidence of localized tenderness. The examiner further opined that the right forearm condition did not have any functional impact on the Veteran’s ability to work. The Board has reviewed the lay testimony of record as well as the VA and private medical records in the claims file, but this evidence does not tend to show that the symptoms of right forearm pain warranted a rating in excess of 10 percent prior to December 21, 2016. There was no evidence of any impairment of function sufficient to warrant a compensable rating under any of the applicable Diagnostic Codes outlined above, and so the Board cannot assign a higher or separate rating under any of those diagnostic codes. Typically, this would result in a noncompensable rating; however, the currently assigned 10 percent rating for the period prior to December 21, 2016 was granted with consideration of the functional loss stemming from the Veteran’s right forearm pain, as painful motion of a joint due to arthritis equates to limited motion pursuant to Diagnostic Code 5003. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 208. With that being said, as the 10 percent rating is already compensating the Veteran for the functional impact of his right forearm pain where the condition would otherwise be rated as noncompensable, the Board will not assign a rating in excess of that 10 percent when the only functional impact reflected by the evidence is that pain. Accordingly, the Board finds that a rating in excess of 10 percent for right forearm pain prior to December 21, 2016 is not warranted. As for the period from December 21, 2016 the Board finds that a rating in excess of 20 percent for right forearm pain is also not warranted. On the most recent VA examination, the Veteran reported experiencing near constant right forearm pain, with flare-ups of pain whenever he put pressure on the right forearm or lifted anything heavier than 10 to 15 pounds. Range of motion testing revealed flexion of 110 degrees and extension of 145 to 10 degrees, while supination was 65 degrees and pronation was 70 degrees. After repetitive use, flexion was reduced to 95 degrees and extension to 95 to 20 degrees, while supination was reduced to 35 degrees and pronation was reduced to 45 degrees. Pain was noted on examination, but it did not cause functional loss. The examiner further acknowledged that there was evidence of localized tenderness as well as pain on weight bearing, although they did not endorse any crepitus. The examiner also noted that the Veteran exhibited limited pronation of his right arm with motion lost beyond the last quarter of the arc. In conclusion, it was the examiner’s opinion that the right forearm pain precluded the Veteran from any work requiring that he lift anything weighing more than 15 pounds, and also that he would need to work in a setting that would allow him to rest his right arm on an elbow cushion. The currently assigned 20 percent rating pursuant to Diagnostic Code 5213 contemplates the limited pronation with motion lost beyond the last quarter of the arc that was noted on the December 21, 2016 VA examination. Although the Veteran exhibited reduced range of motion throughout when compared with the previous examination, that range of motion did not warrant a rating in excess of 20 percent under any of the applicable diagnostic codes. There was no other symptomatology reported by the Veteran or recorded by the examiner which would warrant a rating in excess of 20 percent, and available VA medical records during this time period do not show any such symptomatology either. Although the Veteran detailed that he experienced near-constant right forearm pain that would flare up after weight bearing or lifting, the 20 percent rating for the period from December 21, 2016 was granted with consideration of the functional loss stemming from the Veteran’s pain. For any additional functional loss due to pain to warrant a higher rating, that loss must rise to the level of the more restricted range of motion necessary for entitlement to the next degree of disability, which has not been shown. Therefore, the Board finds that the assigned rating for the period from December 21, 2016 adequately contemplates the functional impairment resulting from the Veteran’s right forearm pain. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 208. In summation, the right forearm pain reported by the Veteran is properly encompassed within the 20 percent rating assigned for the period from December 21, 2016. Accordingly, the Board confirms and continues the currently assigned 20 percent rating for right forearm pain from December 21, 2016. Moving on to the separate rating for right forearm limitation of extension, the RO assigned a noncompensable evaluation pursuant to Diagnostic Code 5207 in acknowledgement that the Veteran exhibited some limitation of extension of his right forearm on the December 21, 2016 VA examination, but not to an extent that would warrant a compensable rating. As a reminder, range of motion testing on that examination showed extension of 145 to 10 degrees, reduced to 95 to 20 degrees after repetitive use. Diagnostic Code 5207 does not provide for a compensable rating for limitation of extension unless the arm is limited to extension of at least 45 degrees, which has not been shown here. There are no other specific diagnostic codes that apply to the evaluation of the limitation of extension of an arm, and so there is no alternative diagnostic code that could provide for a compensable rating for limitation of extension of the right forearm. That said, the Board is cognizant of 38 C.F.R. § 4.59, which indicates that a minimum compensable rating (10 percent), though not more, is warranted for actually painful joints. As noted above, such is the case with the right forearm. On that basis, an initial 10 percent evaluation is warranted for right forearm limitation of extension, and this claim is granted to that extent. Entitlement to an effective date earlier than December 21, 2016 for the grant of service connection and an initial noncompensable rating for a right forearm condition with limitation of extension. Generally, the effective date for an award of compensation or claim for increase is the date of receipt of the claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The date of entitlement is the date the claimant meets the basic eligibility criteria for the benefit. Additionally, 38 U.S.C. § 5101(a) provides that “[a] specific claim in the form prescribed by the Secretary... must be filed in order for benefits to be paid or furnished to any individual.” For claims for an increase in a service-connected disability, if an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was “factually ascertainable.” If the increase occurred more than one year prior to the claim, the increase is effective the date of claim. If the increase occurred after the date of claim, the effective date is the date of increase. 38 U.S.C. 5110(b)(2); 38 C.F.R. 3.400(o). For VA compensation purposes, a “claim” is defined as “a written communication requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit under the laws administered by the Department of Veterans Affairs submitted on an application form prescribed by the Secretary.” 38 C.F.R. § 3.1(p). An informal claim is “[a]ny communication or action indicating an intent to apply for one or more benefits.” 38 C.F.R. § 3.155(a). It must “identify the benefit sought.” Id. Thus, the essential elements for any claim, whether formal or informal, are “(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing.” Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). VA must look to all communications from a claimant that may be interpreted as an application or claim, both formal and informal, for benefits and is required to identify and act on informal claims for benefits. See Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). In addition, an application that had been previously denied cannot preserve an effective date for a later grant of benefits based on a new application. 38 C.F.R. § 3.400(q). Thus, the effective date of an award of service connection is not based on the earliest medical evidence showing a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999). The Veteran’s right forearm condition was newly evaluated via a VA examination dated in December 21, 2016 that was conducted pursuant to the Board’s October 2016 Remand. In a January 2017 rating decision, the Veteran was awarded a separate noncompensable rating for right forearm limitation of extension. The Veteran did not initiate any claim in pursuit of a separate rating for his right forearm limitation of extension, and thus the effective date must then stem solely from the date that entitlement to the separate rating arose. To that end, the Board finds that the record does not establish that it was factually ascertainable that the Veteran was experiencing right forearm limitation of extension at any point prior to December 21, 2016. VA and private medical records do not reflect that prior to the VA examination the Veteran had reported or sought treatment for limitation of extension of his right forearm. Accordingly, the Board concludes that the first point at which it was factually ascertainable that the Veteran was experiencing right forearm limitation of extension was the current effective date of December 21, 2016, the date of the VA examination. As such, the Veteran is not entitled to an effective date prior to when it became clear his right forearm condition had manifested in this new manner, and the claim is denied. Temporary Total Rating Pursuant to 38 C.F.R. §§ 4.29 and 4.30 The Veteran seeks entitlement to a temporary total rating under the provisions of either 38 C.F.R. § 4.29 based on hospitalization for a period of more than 21 days or 38 C.F.R. § 4.30 based on the need for convalescence following the May 2014 lumbar spine surgery. With regard to the 38 C.F.R. § 4.29 claim, a total disability rating will only be assigned where a service-connected disability requires hospital treatment for a period in excess of 21 days. Here, available records show that the Veteran underwent lumbar spine surgery on May 30, 2014, and was discharged two days later on June 1, 2014. Since the Veteran’s lumbar spine surgery did not require the necessary 21 days of hospitalization, VA may not grant under 38 C.F.R. § 4.29. As for the 38 C.F.R. § 4.30 claim, the applicable regulations provide that a temporary total rating may be assigned for a period of one, two, or three months if at least one month of convalescence is necessitated by surgery for a service-connected disability, with such benefits payable from the date of entrance into the hospital or the date of outpatient treatment for the period in question. 38 C.F.R. §§ 3.401(h)(2), 4.30. In order to attain a temporary total rating, the Veteran must demonstrate that his service-connected disability resulted in (1) surgery necessitating at least one month of convalescence; (2) surgery with severe post-operative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. After reviewing the totality of the record, the Board finds the weight of the evidence is against the assignment of a temporary total rating under 38 C.F.R. § 4.30. The Board has considered the Veteran’s own statements, testimony, and the post-surgical medical evidence. Overall, such evidence does not demonstrate that at least one month of convalescence was required or indicate the presence of severe post-operative residuals warranting the assignment of a temporary total rating. The Board does acknowledge that the Veteran has stated that he required convalescence for an entire year following his surgery, and certainly at least three months. Furthermore, the Board is aware that the Veteran’s treating family physician, a Dr. P.B., stated in a September 2016 correspondence that the Veteran required one year of total convalescence following the May 2014 surgery, without further explanation. However, these assertions do not accord with the evidence of record. To begin, the operative report detailing the May 30, 2014 surgery does not specify that the Veteran would require any specific post-operative period of convalescence following the surgery. Available physical therapy treatment records show that he first reported for physical therapy on July 29, 2014, and continued thereafter twice a week for six weeks, to ultimately continue until January 2015. An initial evaluation report shows that he was rated as having slight impairment. The Veteran reported at that time that he was avoiding carrying out physical activities and was not working in normal occupation in construction. Records show that by October 2014 the Veteran reported that he had returned to work and was carrying out physical activities while at work or at home without any increased pain. He was given no precautions when released at the final physical therapy session on January 5, 2015. The November 2016 VA spine examiner was asked to opine as to the specific post-operative limitations experienced by the Veteran in the months following the May 30, 2014 surgery. After reviewing the record, and acknowledging Dr. P.B.’s September 2016 correspondence, the examiner found no evidence that the Veteran required any doctor-prescribed convalescence following his surgery. In support thereof, the examiner referenced the operative report which detailed no post-operative restrictions, as well as the physical therapy records which showed only that the Veteran was avoiding physical activity while at home and did not go back to work until October 2014. In sum, the evidence does not show, nor does the Veteran contend, that convalescence or home confinement was medically required for at least one month following the May 2014 lumbar spine surgery. Further, the record does not support a finding that the Veteran sustained severe post-operative residuals such as incompletely healed surgical wounds, nor has he contended this. Moreover, the record does not show, and the Veteran has not alleged, that he had stumps of recent amputations, therapeutic immobilization of a joint, application of a body cast, or symptoms necessitating the use of wheelchair or crutches. Finally, there is no evidence that the surgery resulted in immobilization by cast, without surgery, of one major joint or more. In essence, there is no evidentiary support for either the 38 C.F.R. § 4.29 claim or the 38 C.F.R. § 4.30, and the claim must be denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to a temporary total rating for hospitalization for 21 days or more pursuant to 38 C.F.R. § 4.29 as well as the claim of entitlement to a temporary total rating for convalescence pursuant to 38 C.F.R. § 4.30. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND Entitlement to an effective date prior to November 30, 2016 for the grant of a TDIU is remanded. In a December 2016 addendum to the November 2016 VA examination, a VA examiner determined that the Veteran’s various service-connected disabilities, taken together, would preclude him from any occupation requiring manual labor or physically demanding or strenuous activity. Furthermore, the examiner opined that the lumbar spine condition by itself rendered it less likely than not that the Veteran would by capable of successfully securing and following substantially gainful occupation. Thereafter, in a later VA examination dated in December 2016, a different VA examiner found instead that the Veteran would still be able to be gainfully employed in a sedentary or supervisory occupation. In setting forth this opinion, the examiner referred to extensive physical therapy reports following the Veteran’s lumbar spine surgery in May 2014 in which the Veteran reported carrying out physical labor on a regular basis. The Board also notes that the record contains an January 2017 employment questionnaire from Eastern Utility Contracting which indicated that the Veteran performed excavation, pipe work, and electrical work for the company from February 2016 to July 2016. According to the report no concessions were made for the Veteran as due to his disabilities, and he stopped working with the company due to a lack of work, and not due to his service-connected disabilities. In order to ascertain whether the Veteran’s service-connected disabilities precluded him from securing and maintaining substantially gainful employment at any point prior to November 30, 2016, the RO must provide the claims file to a VA examiner for the purpose of eliciting a retrospective opinion as to the occupational impact of the service-connected disabilities up to one year prior to the date of his initial claim for increased rating. In this regard, the Board looks to September 16, 2015, the date of a correspondence from the Veteran’s local congressman, as this was the date that the RO was first made aware that he was seeking an increased rating for his lumbar spine condition. 38 C.F.R. § 3.155(a); see also Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). Entitlement to an effective date prior to November 30, 2016 for eligibility to Dependents’ Educational Assistance under 38 U.S.C. Chapter 35 is remanded. The Veteran was granted Dependents’ Educational Assistance under 38 U.S.C. Chapter 35 on the basis of the TDIU that provided him with a total disability rating for the various disabilities stemming from his service-connected lumbar spine condition. Thus, this claim must be deferred pending resolution of the TDIU earlier effective date claim, as such claims are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matter is REMANDED for the following action: Send the Veteran’s claims file to a qualified examiner to provide a retrospective opinion regarding the functional impact of the Veteran’s various service-connected disabilities on his ability to work prior to November 30, 2016. The claims file, to include a copy of this remand, must be made available prior to completion of the evaluation. Attention is directed to the January 2017 rating codesheet listing the service-connected disabilities. The examiner is requested to review the claims file, including physical therapy records dating from the period following the Veteran’s May 2014 lumbar spine surgery and a January 2017 employment questionnaire from Eastern Utility Contracting, Inc. (which indicates that the Veteran was able to work doing various physical labor activities from February 2016 to July 2016). In providing an opinion as to the extent to which service-connected disabilities affected the ability to secure and follow a substantially gainful occupation PRIOR TO NOVEMBER 30, 2016, the examiner should specify what kind of work, if any, the Veteran would be able to do during the period in question. The examiner is asked to take the Veteran’s level of education, special training, and previous work experience into consideration, but should disregard the Veteran’s age or any impairment caused by any nonservice-connected disability. The examiner should provide a detailed rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher M. Collins, Associate Counsel