Citation Nr: 18141337 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 02-21 699 DATE: October 10, 2018 ORDER Entitlement to an increased evaluation in excess of 20 percent for left shoulder degenerative osteoarthritis from March 12, 2012, on an extraschedular basis is denied. Entitlement to an increased evaluation in excess of 20 percent prior to July 30, 2010, in excess of 30 percent from July 30, 2010, to May 17, 2011, and in excess of 20 percent from May 18, 2011, for right shoulder degenerative arthritis, on an extraschedular basis is denied. Entitlement to an increased evaluation for lumbar spine disability in excess of 10 percent prior to October 6, 2004, in excess of 20 percent from October 6, 2004, to July 29, 2010, and in excess of 40 percent from July 30, 2010, on an extraschedular basis is denied. Entitlement to an initial evaluation in excess of 20 percent for the time period prior to March 12, 2012, for left shoulder degenerative osteoarthritis is denied. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance of another person is granted. Entitlement to an initial evaluation in excess of 30 percent for left lower extremity peripheral neuropathy due to cold injury is denied. Entitlement to an initial evaluation in excess of 30 percent for right lower extremity peripheral neuropathy due to cold injury is denied. Entitlement to a separate 10 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) is granted. Entitlement to a separate 20 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) is granted. Entitlement to a separate 10 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) is granted. Entitlement to a separate 20 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) is granted. Entitlement to effective date prior to December 13, 2001, for eligibility for Dependents’ Education Assistance (DEA) benefits under 38 U.S.C. Chapter 35 is denied. Entitlement to an effective date prior to December 13, 2001, for the award of entitlement to a total disability rating based on individual unemployability (TDIU) is denied. Entitlement to an effective date prior to July 30, 2010, for the award of a 30 percent evaluation for right shoulder degenerative osteoarthritis is dismissed. Entitlement to an effective date prior to October 6, 2004, for the award of a 20 percent rating for lumbar spine disability is dismissed. Entitlement to an effective date prior to July 30, 2010, for the award of a 40 percent rating for lumbar spine disability is dismissed. Entitlement to an evaluation in excess of 20 percent for right shoulder degenerative osteoarthritis is dismissed. REMANDED Entitlement to an evaluation in excess of 40 percent prior to February 9, 2015, and in excess of 60 percent from February 9, 2015, for multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome is remanded. Entitlement to an effective date prior to February 9, 2015, for the award of a 60 percent rating for lumbar spine disability is remanded. FINDINGS OF FACT 1. The symptoms of left shoulder degenerative osteoarthritis do not present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards regarding this type of disability. 2. The symptoms of right shoulder degenerative osteoarthritis do not present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards regarding this type of disability. 3. The symptoms of multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome do not present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards regarding this type of disability. 4. For the time period prior to March 12, 2012, left shoulder degenerative osteoarthritis is manifested by limitation of left (minor) arm motion to midway between side and shoulder level. 5. Resolving all reasonable doubt in his favor, the Veteran is so helpless as to be in need of regular aid and attendance of another person due to his service-connected disabilities. 6. Left and right lower extremity peripheral neuropathy due to cold injury has been manifested by arthralgia/pain, cold sensitivity, numbness, loss of sensation, and nail abnormalities. 7. The separate complications of the Veteran’s peripheral neuropathy of the right and left lower extremities associated with his cold weather injury also approximate moderate, incomplete paralysis of each musculocutaneous (superficial peroneal) nerve and each anterior crural (femoral) nerve. 8. The Veteran did not have a permanent and total disability prior to December 13, 2001, to establish eligibility for DEA. 9. Neither an earlier claim for entitlement to a TDIU, nor evidence of a factually ascertainable increase in disability occurred so as to merit entitlement to a TDIU during the year preceding December 13, 2001, is contained in the record. 10. The issue of entitlement to an effective date prior to July 30, 2010, for the award of a 30 percent evaluation for right shoulder degenerative osteoarthritis is not properly before the Board because the Board previously adjudicated the matter in a November 2013 decision, and this appeal comes from a September 2014 notice of disagreement with the August 2014 rating decision that effectuated the Board decision. 11. The issue of entitlement to an effective date prior to October 6, 2004, for the award of a 20 percent rating for lumbar spine disability is not properly before the Board because the Board previously adjudicated the matter in a November 2013 decision, and this appeal comes from a September 2014 notice of disagreement with the August 2014 rating decision that effectuated the Board decision. 12. The issue of entitlement to an effective date prior to July 30, 2010, for the award of a 40 percent rating for lumbar spine disability is not properly before the Board because the Board previously adjudicated the matter in a November 2013 decision, and this appeal comes from a September 2014 notice of disagreement with the August 2014 rating decision that effectuated the Board decision. 13. The issue of entitlement to an evaluation in excess of 20 percent for right shoulder degenerative osteoarthritis is not properly before the Board because the Board previously adjudicated the matter in a November 2013 decision, and this appeal comes from a September 2014 notice of disagreement with the August 2014 rating decision that effectuated the Board decision. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased evaluation in excess of 20 percent for left shoulder degenerative osteoarthritis from March 12, 2012, on an extraschedular basis, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 3.321(b)(1) (2017). 2. The criteria for entitlement to an increased evaluation in excess of 20 percent prior to July 30, 2010, in excess of 30 percent from July 30, 2010, to May 17, 2011, and in excess of 20 percent from May 18, 2011, for right shoulder degenerative arthritis, on an extraschedular basis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 3.321(b)(1) (2017). 3. The criteria for entitlement to an increased evaluation for lumbar spine disability in excess of 10 percent prior to October 6, 2004, in excess of 20 percent from October 6, 2004, to July 29, 2010, and in excess of 40 percent from July 30, 2010, on an extraschedular basis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 3.321(b)(1) (2017). 4. The criteria for entitlement to an initial evaluation in excess of 20 percent for the time period prior to March 12, 2012, for left shoulder degenerative osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5201 (2017). 5. The criteria for entitlement to SMC based on the need for the regular aid and attendance have been met. 38 U.S.C. § 1114 (l) (2012); 38 C.F.R. §§ 3.102, 3.350(b), 3.352 (2017). 6. The criteria for entitlement to an initial evaluation in excess of 30 percent for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.14, 4.104, Diagnostic Code 7122 (2017). 7. The criteria for entitlement to an initial evaluation in excess of 30 percent for right lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.14, 4.104, Diagnostic Code 7122 (2017). 8. The criteria for assignment of a separate 10 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, 4.124a, Diagnostic Codes 7122, 8522 (2017). 9. The criteria for assignment of a separate 20 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, 4.124a, Diagnostic Codes 7122, 8526 (2017). 10. The criteria for assignment of a separate 10 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, 4.124a, Diagnostic Codes 7122, 8522 (2017). 11. The criteria for assignment of a separate 20 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, 4.124a, Diagnostic Codes 7122, 8526 (2017). 12. The criteria for entitlement to effective date prior to December 13, 2001, for eligibility for DEA have not been met. 38 U.S.C. §§ 3501, 5110 (2012); 38 C.F.R. §§ 3.807, 21.3021 (2017). 13. The criteria for entitlement to an effective date prior to December 13, 2001, for the award of entitlement to TDIU have not been met. 38 U.S.C. §§ 1155, 5107, 5110 (2012); 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.3, 4.16 (2017). 14. The November 2013 Board decision is final, and the attempted re-litigation of the issue of entitlement to an effective date prior to July 30, 2010, for the award of a 30 percent evaluation for right shoulder degenerative osteoarthritis is dismissed. 38 U.S.C. §§ 511(a), 7103, 7104(a) (2012); 38 C.F.R. § 20.1100 (2017). 15. The November 2013 Board decision is final, and the attempted re-litigation of the issue of entitlement to an effective date prior to October 6, 2004, for the award of a 20 percent rating for lumbar spine disability is dismissed. 38 U.S.C. §§ 511(a), 7103, 7104(a) (2012); 38 C.F.R. § 20.1100 (2017). 16. The November 2013 Board decision is final, and the attempted re-litigation of the issue of entitlement to an effective date prior to July 30, 2010, for the award of a 40 percent rating for lumbar spine disability is dismissed. 38 U.S.C. §§ 511(a), 7103, 7104(a) (2012); 38 C.F.R. § 20.1100 (2017). 17. The November 2013 Board decision is final, and the attempted re-litigation of the issue of entitlement to an evaluation in excess of 20 percent for right shoulder degenerative osteoarthritis is dismissed. 38 U.S.C. §§ 511(a), 7103, 7104(a) (2012); 38 C.F.R. § 20.1100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1952 to December 1956. These matters come before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions. In May 2003, the Veteran testified at videoconference hearing at the RO before a Veterans Law Judge (VLJ) from the Board. A transcript of the hearing is included in the electronic claims file. The Board later notified the Veteran that the VLJ who conducted his May 2003 videoconference hearing before the Board was no longer employed by the Board (due to retirement) and advised him of the opportunity to provide testimony at another hearing before the Board. As the Veteran did not respond to the letter, the Board can now proceed with adjudication. 1. Entitlement to an increased evaluation in excess of 20 percent for left shoulder degenerative osteoarthritis from March 12, 2012, on an extraschedular basis 2. Entitlement to an increased evaluation in excess of 20 percent prior to July 30, 2010, in excess of 30 percent from July 30, 2010, to May 17, 2011, and in excess of 20 percent from May 18, 2011, for right shoulder degenerative arthritis, on an extraschedular basis 3. Entitlement to an increased evaluation for lumbar spine disability in excess of 10 percent prior to October 6, 2004, in excess of 20 percent from October 6, 2004, to July 29, 2010, and in excess of 40 percent from July 30, 2010, on an extraschedular basis Based upon the November 2014 Joint Motion for Remand (Joint Motion) and December 2014 Order, the Court vacated and remanded the portion of the Board’s November 2013 decision that dealt the matters enumerated from 1 to 3 above. The parties determined that the Board failed to provide an adequate statement of reasons or bases to support its finding the Veteran’s appeals did not warrant referral to the Director of Compensation for an extraschedular rating or ratings under the provisions of 38 C.F.R. § 3.321(b)(1). On remand, the Board was instructed to compare Veteran’s level of severity and symptomatology reflected in the evidence of record with the established rating criteria for his service-connected lumbar spine and shoulder disabilities under 38 C.F.R. § 4.71a, Diagnostic Codes 5200-5203 and 5235-5243. In doing so, the Board was also instructed to discuss whether the combined effect of those disabilities rendered his disability picture exceptional or unusual. See Johnson v. McDonald, 762 F.3d 1362, 1365 (Fed. Cir. 2014) (The plain language of § 3.321(b)(1) provides for referral for extraschedular consideration based on the collective impact of multiple disabilities). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for the service-connected disabilities are inadequate. Second, if the schedular evaluations do not contemplate the Veteran’s level of disability and symptomatology and are found inadequate, the Board must determine whether the Veteran’s disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” Third, if the rating schedule is inadequate to evaluate a veteran’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of Compensation and Pension to determine whether, to accord justice, the Veteran’s disability picture requires the assignment of an extraschedular rating. A comparison between the level of severity and symptomatology of the Veteran’s assigned evaluations for the service-connected lumbar spine and shoulder disabilities with the established criteria found in the rating schedule shows that the rating criteria reasonably describe most the Veteran’s disability levels and symptomatology. In this regard, the Board finds that the Veteran’s reports pain, tenderness, fatigability, weakness, and functional limitation as well as findings of limitation of motion, gait disturbance, lordosis, degenerative arthritis, shoulder tendonitis, intervertebral disc syndrome, and functional loss/impairment during the applicable periods that constitute symptomatology and impairment contemplated in the rating criteria for his service-connected lumbar spine and shoulder disabilities. However, evidence of record also included various complaints for lumbar spine and right shoulder disabilities, such as must elevate feet for two hours a day to relieve pain, difficulty with activities of daily living (eating, dress, personal care, etc.), sleeping difficulties, and limited ability to stand, sit, stoop, bend, and carry heavy objects. In a February 2016 Remand, the Board directed the RO to refer these matters to the Director of Compensation Service for administrative review in consideration for assignment of any extraschedular rating or ratings under the provisions of 38 C.F.R. § 3.321(b)(1). In the memorandum received from the Director of Compensation Service in May 2017, it was noted that none of the available evidence revealed any functional restrictions secondary to the degenerative disc disease (DDD) of the spine or bilateral shoulder arthritis (or the combined effect of the DDD of the spine and the bilateral shoulder arthritis) that would warrant an increased evaluation on any basis for any time period. It was further indicated that entitlement to individual unemployability benefits was established on a schedular basis effective December 13, 2001, the earliest date that service connection was established for any disability. The Director highlighted that extraschedular evaluations are assigned in cases where an exceptional or unusual disability picture is presented with such related factors as marked interference with employment or frequent periods of hospitalization that renders application of regular rating schedular standards impractical. No unusual or exceptional disability pattern has been demonstrated that would render application of the regular rating criteria as impractical. It was noted that the evidentiary record did not demonstrate that the symptomatology consistently associated with the service-connected DDD of the spine or arthritis of either shoulder was not wholly contemplated by the criteria utilized to assign the current and past evaluations. The Director then specifically concluded that entitlement to an increased evaluation on an extraschedular basis for DDD of the spine or arthritis of either shoulder was not established. As evidence of record associated with these claims support the findings of the Director and does not support any finding that the case presents such exceptional or unusual disability pictures with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of regular schedular standards for the Veteran’s service-connected lumbar spine and shoulder disabilities during the time periods in question. The Board acknowledges that the Veteran has asserted that he ultimately retired in 2000 from being a plumber in an attempt to avoid physical work that would exacerbate his lumbar spine and bilateral shoulder symptoms. But the Board finds that the weight of the evidence does not show that his disabilities have impaired his employability to an extent greater than what is already contemplated in the disability ratings assigned during the periods outlined above. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (explaining that the disability rating, itself, is recognition that industrial capabilities are impaired). Further, 38 C.F.R. § 4.1 specifically sets out that “[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.” Factors such as requiring periodic medical attention are clearly contemplated in the Schedule and provided for in the evaluations assigned herein. What the evidence does not demonstrate in this case is that the manifestations of the Veteran’s service-connected disabilities have resulted in unusual disability or impairment that has rendered the criteria and/or degrees of disability contemplated in the Schedule impractical or inadequate. Evidence of record also does not support finding that the Veteran’s service-connected lumbar spine and shoulder disabilities resulted in repeated hospitalizations. Based on the foregoing, the Board finds that the requirements for any extraschedular evaluation for the Veteran’s service-connected lumbar spine and shoulder disabilities under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995); Thun, supra. Finally, the Court recently held that the revised 38 C.F.R. § 3.321(b), which eliminates the possibility of extraschedular consideration based on the collective impact of multiple service-connected disabilities, can be applied to cases that were pending before VA on January 8, 2018, as doing so does not have an impermissible retroactive effect. Thurlow v. Wilkie, No. 16-3633, U.S. App. Vet. Claims (Sept. 12, 2018). Thus, the Board is now not required to discuss whether the combined effect of the Veteran’s service-connected lumbar spine and shoulder disabilities rendered his disability picture exceptional or unusual under Johnson. 4. Entitlement to an initial evaluation in excess of 20 percent for the time period prior to March 12, 2012, for left shoulder degenerative osteoarthritis The Veteran has been awarded a 20 percent evaluation for his service-connected left shoulder degenerative arthritis during this appeal period from December 13, 2001, and prior to March 12, 2012, under Diagnostic Codes 5003-5201. He continues to seek a higher rating during this time period of his appeal. The hyphenated diagnostic code indicates that degenerative arthritis under Diagnostic Code 5003 is the service-connected disorder, and limitation of right arm motion under Diagnostic Code 5201, is the residual condition. 38 C.F.R. § 4.27 (2017). A distinction is made between major/dominant and minor/nondominant musculoskeletal groups for rating purposes. 38 C.F.R. § 4.69 (2017). As evidence of record shows that the Veteran is right hand dominant, his left shoulder is designated as his nondominant/minor shoulder or arm for the purposes of this decision. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Under Diagnostic Code 5200, ankylosis of the scapulohumeral articulation, manifested by favorable abduction to 60 degrees, allowing the mouth and head to be reached (30 percent for the major dominant side and 20 percent for the minor non-dominant side). This code also provides that ankylosis of the scapulohumeral articulation, manifested by intermediate between favorable and unfavorable allows for 40 percent for the major side and 30 percent for the minor side. Unfavorable abduction limited to 25 degrees from side provides for a 50 percent rating (major) and 40 percent (minor). 38 C.F.R. § 4.71a, Diagnostic Code 5200 (2017). Under Diagnostic Code 5201, limitation of motion of the arm, a 20 percent rating is assigned when there is limitation of motion of the major or minor arm at shoulder level. A 30 percent rating is warranted when there is limitation of motion of the major arm midway between the side and shoulder level. This warrants a 20 percent rating in the minor arm. A 40 percent evaluation is warranted when there is limitation of motion of the major arm to 25 degrees from the side. This warrants a 30 percent rating in the minor arm. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2017). Under Diagnostic Code 5202, other impairment of the humerus, a 20 percent evaluation is warranted for impairment of the major/minor extremity caused by malunion resulting in moderate deformity, or for recurrent dislocation of the scapulohumeral joint with infrequent episodes of dislocation at the scapulohumeral joint and guarding of movement at the shoulder level. A 30 percent evaluation is warranted for impairment of the major extremity caused by malunion resulting in marked deformity or for recurrent dislocation of the scapulohumeral joint with frequent episodes of dislocation and guarding of all arm movements. This warrants a 20 percent evaluation in the minor arm. A 50 percent evaluation is assigned where there is fibrous union in the major arm, and a 40 percent evaluation is assigned where there is fibrous union in the minor arm; a 60 percent evaluation is warranted for nonunion or a false flail joint in the major arm, and a 50 percent evaluation is warranted for nonunion or a false flail joint in the minor arm; and for loss of the humeral head (a flail shoulder), an 80 percent evaluation is warranted in the major arm, and a 70 percent evaluation is warranted in the minor arm. 38 C.F.R. § 4.71a, Diagnostic Code 5202 (2017). Under Diagnostic Code 5203, a 10 percent evaluation is warranted for nonunion of the clavicle or scapula, without loose movement or malunion of the clavicle or scapula. A 20 percent evaluation is warranted for dislocation of the clavicle or scapula or nonunion of the clavicle or scapula, with loose movement. These evaluations are the same for either the major or minor arm. 38 C.F.R. § 4.71a, Diagnostic Code 5203 (2017). To give the Veteran every consideration in connection with the matter on appeal, the Board will also consider all other potentially applicable diagnostic codes under 38 C.F.R. § 4.71a in rating the Veteran’s left shoulder disability during the appeal period. See, e.g., Butts v. Brown, 5 Vet. App. 532, 538 (1993) (the assignment of a particular diagnostic code is “completely dependent on the facts of a particular case”), and Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992) (one diagnostic code may be more appropriate than another based on such factors as the Veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examinations on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45 (2017). The Court has held that the RO must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by the Court in DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. The Board further recognizes that the Court recently determined that pain alone does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (2017); see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 is not limited to arthritis); Correia v. McDonald, 28 Vet. App. 158 (2016). For the time period prior to March 12, 2012, a rating in excess of 20 percent is not warranted for the Veteran’s service-connected left shoulder degenerative arthritis under 38 C.F.R. § 4.71a, Diagnostic Codes 5003 and 5200-5203. Favorable or unfavorable ankylosis of the shoulder joint or other impairment of the humerus (loss of head, nonunion, or fibrous union) is simply not shown in the evidence of record. The Veteran’s limitation of motion of the left shoulder also does not equate limitation of minor arm motion to 25 degrees from his side and as a result a higher rating under Diagnostic Code 5201 is also not warranted. While the Board is cognizant that an isolated July 2010 private treatment record showed left arm “extension” to 20 degrees, evidence of record during this time period showed that the Veteran consistently demonstrated (with or without pain) left shoulder abduction to 80 degrees or more, left shoulder flexion to 60 degrees or more, left shoulder internal/external rotation to 40 degrees or more in VA examination reports dated in July 2006 and May 2011. The Board further finds that there is no basis for the assignment of any higher rating based on consideration of functional loss of the left shoulder during this time period. 38 C.F.R. §§ 4.40, 4.45, 4.59 (2017); Deluca, 8 Vet. App. at 204-06; Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011); Correia, 28 Vet. App. at 158. Even with the Veteran’s assertions of pain, weakness, reduced range of motion, flare-ups, and functional limitation, he has not demonstrated limitation of motion in the minor left arm to warrant the assignment of any higher evaluation. Even with the physical restrictions on his shoulders with standing, sitting, walking, weightbearing, and repetitive/continuous activities outlined in the July 2010 private treatment record, the evidence reflects that the currently assigned 20 percent rating properly compensates him for the extent of functional loss resulting from painful motion, fatigue, weakness, stiffness, and tenderness in the left shoulder. The available medical findings do not show that painful motion, limitation of motion on repetitive use or during flare-ups, or pain or limitation of motion resulted in functional loss warranting the assignment of any higher evaluation during the appeal period. Generally, evaluating a disability using either the corresponding or analogous diagnostic codes contained in the Rating Schedule is sufficient. 38 C.F.R. §§ 4.20, 4.27 (2017). However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual veteran’s circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. Nonetheless, in exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b) (2017); see also Thun v. Peake, 22 Vet. App. 111 (2008). Here, the Board will not address whether referral for an extraschedular rating is warranted. Neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017). In this case, evidence of record showed no distinct periods of time during the appeal period when the Veteran’s service-connected left shoulder disability varied to such an extent that a rating greater or less than the rating currently assigned would be warranted. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the assignment of any additional higher evaluations for the Veteran’s service-connected left shoulder disability, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to SMC based on aid and attendance Special monthly compensation based on the need for aid and attendance of another is payable when the veteran, due to service-connected disability, is so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l) (2012); see also 38 C.F.R. § 3.350(b) (2017). Pursuant to 38 C.F.R. § 3.352(a), the following criteria are to be considered for determining whether a claimant is in need of the regular aid and attendance of another person: (1) the inability of the claimant to dress himself or to keep himself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliance which, by reason of the particular disability, cannot be done without aid; (3) the inability of the claimant to feed himself through the loss of coordination of the upper extremities or through extreme weakness; (4) the inability to attend to the wants of nature; or, (5) a physical or mental incapacity that requires care and assistance on a regular basis to protect the claimant from the hazards or dangers incident to his or her daily environment. A veteran need only show one of the enumerated factors identified in 38 C.F.R. § 3.352(a) to establish entitlement to aid and attendance. Turco v. Brown, 9 Vet. App. 222, 224 (1996). Moreover, it is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. The performance of the necessary aid and attendance service by a relative of the claimant or other member of his or her household will not prevent the granting of the additional allowance. 38 C.F.R. § 3.352(c). The Veteran receives VA compensation benefits for the following disabilities: right and left shoulder degenerative osteoarthritis, right and left lower extremity peripheral neuropathy due to cold injury, and multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome. In a January 2017 VA DBQ report filled out by a private treatment provider, it was noted that the Veteran needed assistance with ambulation, meals, and performing self-care as well as could not leave house without assistance. It was indicated that the Veteran’s bilateral lower extremity peripheral neuropathy caused ongoing gait disturbance. In a February 2017 VA Aid and Attendance examination report, the Veteran was noted to use a manual wheelchair, cane, and walker within his home but reported falling a few times a month. He indicated that he used an electric scooter outside the home and that his family installed ramps for handicap accessibility into his home. He was noted to have some difficulty in ability for feeding, dressing, bathing, and toileting as well as to be without normal function of both upper and lower extremities with noted muscle weakness and lack of coordination. It was indicated that physical impairments affected his ability to protect himself from his daily environment due to multiple falls a month. The examiner then opined that it was at least as likely as not that the Veteran would benefit from aid and attendance and requires the regular assistance of another person in attending to the ordinary activities of daily living as well as requires the assistance of another in protecting himself from the ordinary hazards of his daily environment. Based on the foregoing discussion, the Board has determined that the evidence is at least in relative equipoise as to whether the Veteran’s service-connected disabilities cause him to be so helpless, as to be in need of actual personal assistance from others. Resolving all reasonable doubt in favor of the Veteran, entitlement to SMC based on the need for aid and attendance of another person is warranted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017). Finally, whether the Veteran is entitled to SMC at the housebound rate is moot, as SMC based on the need for aid and attendance of another person is the greater monetary benefit. 38 U.S.C. § 1114(l), (s) (2012). 6. Entitlement to an initial evaluation in excess of 30 percent for left lower extremity peripheral neuropathy due to cold injury 7. Entitlement to an initial evaluation in excess of 30 percent for right lower extremity peripheral neuropathy due to cold injury 8. Entitlement to a separate 10 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) 9. Entitlement to a separate 20 percent rating for peripheral neuropathy of the left lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) 10. Entitlement to a separate 10 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (musculocutaneous nerve (superficial peroneal)) 11. Entitlement to a separate 20 percent rating for peripheral neuropathy of the right lower extremity associated with a cold weather injury (anterior crural nerve (femoral)) The Veteran’s cold injury residuals affecting the right and left lower extremities have been evaluated under Diagnostic Code 7122 (cold injury residuals). See 38 C.F.R. § 4.104, Diagnostic Code 7122. An initial 30 percent rating has been in effect from December 13, 2001, which constitutes the maximum assignable ratings per Diagnostic Code 7122. Pursuant to Diagnostic Code 7122, 30 percent disability rating is warranted for, in affected parts, arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis). Note (1) to Diagnostic Code 7122 states that amputations of fingers or toes and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy are to be separately evaluated under other codes. Other disabilities that have been diagnosed as the residual effects of a cold injury, such as Raynaud’s phenomenon, muscle atrophy, etc., also are to be separately evaluated unless they are used to support an evaluation under Diagnostic Code 7122. Note (2) provides that each affected part is to be evaluated separately. Id. Diseases affecting the nerves are rated on the basis of degree of paralysis, neuritis, or neuralgia under 38 C.F.R. § 4.124a. For paralysis of the musculocutaneous (superficial peroneal) nerve, a zero percent/noncompensable rating is warranted for mild incomplete paralysis; a 10 percent rating is warranted for moderate incomplete paralysis; and a 20 percent rating is warranted for severe incomplete paralysis. A 30 percent rating is warranted for complete paralysis evidenced by eversion of foot weakened. 38 C.F.R. § 4.124a, Diagnostic Code 8522 (2017). For paralysis of the anterior crural (femoral) nerve, a 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; and a 30 percent rating is warranted for severe incomplete paralysis. A 40 percent rating is warranted for complete paralysis evidenced by paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8526 (2017). The term “incomplete paralysis” indicates a degree of impaired function substantially less than the type of picture for “complete paralysis” given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note. When the involvement is wholly sensory, the rating for incomplete paralysis should be for the mild, or, at most, the moderate degree. Id. Moderate incomplete paralysis will likely be described by the veteran and medically graded as significantly disabling and may be demonstrated by combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate. See VBA Adj. Manual M21-1, III.iv.4.G.4.c. The Court recently held in Miller v. Shulkin that, “[a]lthough the note preceding § 4.124a directs the claims adjudicator to award no more than a 20 percent disability rating for incomplete paralysis of a peripheral nerve where the condition is productive of wholly sensory manifestations, it does not logically follow that any claimant who also exhibits non-sensory manifestations must necessarily be rated at a higher level.” 28 Vet. App. 376, 380 (2017). Except as otherwise provided in the rating schedule, all disabilities, including those arising from a single disease entity, are to be rated separately, and then all ratings are to be combined pursuant to 38 C.F.R. § 4.25 (2017). Esteban v. Brown, 6 Vet. App. 259, 261 (1994). However, the Court has interpreted 38 U.S.C. § 1155 as implicitly containing the concept that the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity and would constitute pyramiding of disabilities, which is cautioned against in 38 C.F.R. § 4.14 (2017). In Esteban, the Court held that the critical element was that none of the symptomatology for any of the conditions was duplicative of or overlapping with the symptomatology of the other conditions. Entitlement to initial evaluations in excess of 30 percent for each extremity during the appeal period from December 13, 2001, are not warranted. Evidence of record, including VA treatment records dated from 2001 to 2017, private treatment notes, and VA examination reports dated in July 2009, March 2012, and February 2015, detailed complaints and finding of feet feeling cold to touch and numb all the time, chronic pain and numbness in both feet, burning sensation, onychomycosis with dystrophy of both big toenails, left foot osteoarthritis, dermatophytosis of nails, hammertoes at toes 2-5 bilaterally, and no ulcers, discoloration or calluses. The July 2009 VA examiner listed a diagnosis of peripheral neuropathy of both legs and feet, most likely secondary to cold injury. EMG/NCV studies conducted in 2009, 2011, and 2012 were noted to reveal severe axonal sensorimotor polyneuropathy in the lower extremities. The February 2015 VA cold injury examination report reflected continued findings of constant pain and numbness in the bilateral lower extremities due to neuropathy, the only diagnosis that pertained to the Veteran’s cold injuries. In the February 2015 VA peripheral nerve examination report, the Veteran reported bilateral lower extremity constant moderate pain, moderate paresthesias, and moderate numbness. The examiner noted no muscle atrophy, hypoactive lower extremity reflexes, absent sensation in the lower extremities, abnormal (slow and unsteady) gait, and moderate incomplete paralysis of two bilateral lower extremity nerves, to include the musculocutaneous (superficial peroneal) nerve and the anterior crural (femoral) nerve. The Veteran was noted to have constant pain/numbness and minimal use of his legs. The Veteran was assigned the maximum schedular criteria of 30 percent for his right and left lower extremity peripheral neuropathy due to cold injuries effective December 13, 2001 (date of his service connection claim for frozen feet) based on pain, numbness, cold sensitivity, nail abnormalities, and locally impaired sensation. This is the maximum schedular evaluation allowable by law for cold residual injuries. Therefore, a higher rating is not warranted under Diagnostic Code 7122. In addition, the Board finds that the Veteran’s diagnosed skin conditions, dermatophytosis and onychomycosis with dystrophy of both big toe nails, are already accounted for in his current rating for cold injuries under Diagnostic Code 7122. Significantly, nail abnormalities are a factor that was considered by the RO when granting the assigned initial separate 30 percent ratings for his bilateral lower extremity residuals of peripheral neuropathy due to cold injuries. Therefore, to separately compensate the Veteran for those symptoms would constitute pyramiding, which is prohibited by VA regulations. 38 C.F.R. § 4.14. The Board has also determined that the Veteran is entitled to the assignment of separate ratings of 20 percent for moderate incomplete paralysis of the anterior crural (femoral) nerve bilaterally and 10 percent for moderate incomplete paralysis of the musculocutaneous (superficial peroneal) nerve bilaterally. Parenthetically, the Board highlights that it is not always pyramiding to assign more than one rating if involving different nerve branches under the rating criteria for nerves affecting the lower extremities. See M21-1, III.iv.4.N.4.e and f. Evidence of record showed no distinct periods of time during the appeal period when the Veteran’s service-connected right and left lower extremity residuals varied to such an extent that any rating greater or less than the ratings currently assigned would be warranted. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board will also not address whether referral for an extraschedular rating is warranted. Neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Finally, in reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the assignment of any additional higher evaluations for the Veteran’s service-connected right and left lower extremity peripheral neuropathy due to cold injury, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 12. Entitlement to effective date prior to December 13, 2001, for eligibility for DEA 13. Entitlement to an effective date prior to December 13, 2001, for the award of entitlement to TDIU The Veteran seeks earlier effective dates for the awards of TDIU and DEA eligibility prior to December 13, 2001 (the date he was first awarded service connection for any disability and later, the date he was assigned a combined 80 percent total evaluation for his service-connected disabilities). Evidence of record detailed that his assertions that he retired in 2000 as a self-employed plumber due to his service-connected bilateral shoulder disabilities. The schedular requirements for TDIU under 38 C.F.R. § 4.16(a) were met as of December 13, 2001. Awards of TDIU are governed by the effective date rules applicable to awards of increased compensation. See, e.g., Hurd v. West, 13 Vet. App. 449 (2000). The general rule is that the effective date of such an award shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400(o)(1) (2017). Date of receipt means the date on which a claim, information, or evidence was received by VA. 38 C.F.R. § 3.1(r) (2017). An exception to that rule applies under circumstances where evidence demonstrates a factually ascertainable increase in disability during the one-year period preceding the date of receipt of a claim for increased compensation. In that situation, the law provides that the effective date of the award “shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date.” 38 U.S.C. § 5110(b)(2) (2012); 38 C.F.R. § 3.400(o)(2) (2017); Harper v. Brown, 10 Vet. App. 125 (1997). In all other cases, the effective date will be the “date of receipt of claim or date entitlement arose, whichever is later.” 38 C.F.R. § 3.400(o)(1) (2017); VAOPGCPREC 12-98, 63 Fed. Reg. 56,703 (Oct. 22, 1998). Therefore, three possible dates may be assigned depending on the facts of a case: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) (38 C.F.R. § 3.400 (o)(1)); (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (factually ascertainable) (38 C.F.R. § 3.400(o)(2)); or (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) (38 C.F.R. § 3.400 (o)(2)). Harper, 10 Vet. App. at 126. In determining an effective date for an award of a TDIU, VA must make two essential determinations. It must determine (1) when a claim for TDIU was received, and (2) when a factually ascertainable increase in disability occurred so as to warrant entitlement to TDIU. 38 C.F.R. §§ 3.155, 3.400(o)(2) (2017). With respect to the first of these determinations (when a claim for TDIU was received), the Board notes that, once a formal claim for VA benefits has been filed, a subsequent informal request for increase will be accepted as a claim. 38 C.F.R. § 3.155(c) (2015). Generally, the informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (2015). However, an informal claim for TDIU need not be specifically labeled as such. Indeed, the United States Court of Appeals for the Federal Circuit has held that VA has a duty to determine all potential claims raised by the evidence, applying all relevant laws and regulations, and that once a veteran submits evidence of a medical disability and makes a claim for the highest rating possible, and additionally submits evidence of unemployability, VA must consider entitlement to TDIU. Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001); see also Rice v. Shinseki, 22 Vet. App. 447 (2009). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Because the Veteran’s claim was received by VA prior to that date, the former regulations apply. With regard to the second of the aforementioned determinations (when a factually ascertainable increase in disability occurred so as to warrant entitlement to TDIU), the Board notes that TDIU may be awarded, where a veteran’s schedular rating is less than total, if evidence is received to show that he is unable to secure or follow a substantially gainful occupation as a result of service-connected disability. 38 C.F.R. § 4.16 (2017). Normally, consideration is given to such an award only if the veteran has a single service-connected disability ratable at 60 percent or more, or if he has two or more such disabilities with a combined rating of 70 percent or more, with at least one disability ratable at 40 percent or more. 38 C.F.R. § 4.16(a) (2017). However, failure to satisfy these percentage standards is not an absolute bar to an award of TDIU. 38 C.F.R. § 4.16(b) (2017). Rather, “[i]t is the established policy of [VA] that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled.” Id. Evidence of record simply does not provide a basis for assignment of an effective date earlier than December 13, 2001, for entitlement to a TDIU rating on a schedular or extraschedular basis. Neither an earlier claim for TDIU, nor evidence of a factually ascertainable increase in disability occurred so as to merit entitlement to a TDIU during the year preceding December 13, 2001, is contained in the record. Therefore, the assignment of an effective date earlier than December 13, 2001, is not warranted. As the Board finds that the preponderance of the evidence is against the Veteran’s earlier effective date claim, the benefit of the doubt doctrine does not apply. See Schoolman v. West, 12 Vet. App. 307, 311 (1999). Basic eligibility exists for DEA benefits under 38 U.S.C. Chapter 35 where the Veteran was discharged from service under conditions other than dishonorable and has a total disability permanent in nature as a result of a service-connected disability. 38 U.S.C. § 3501(a)(1) (2012); 38 C.F.R. §§ 3.807(a), 21.3021 (2017). With certain exceptions that are not applicable to the instant claim, the effective date for the grant of such award shall, to the extent feasible, correspond to effective dates for awards of disability compensation. 38 U.S.C. § 5113(a) (2012). A total disability may be assigned where the Veteran’s service-connected disabilities are rated 100 percent disabling under the rating schedule, or if the Veteran is unemployable due to service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341. Here, the currently assigned effective date of December 13, 2001, for basic eligibility for DEA benefits is directly related to an award of a TDIU rating. As discussed above, the Board has found that entitlement to a TDIU rating prior to this date is not warranted. As such, the claim for an effective date prior to December 13, 2001, for eligibility for DEA benefits must also be denied. 14. Entitlement to an effective date prior to July 30, 2010, for the award of a 30 percent evaluation for right shoulder degenerative osteoarthritis 15. Entitlement to an effective date prior to October 6, 2004, for the award of a 20 percent rating for lumbar spine disability 16. Entitlement to an effective date prior to July 30, 2010, for the award of a 40 percent rating for lumbar spine disability 17. Entitlement to an evaluation in excess of 20 percent for right shoulder degenerative osteoarthritis In November 2013, the Board issued a decision wherein it granted a 30 percent evaluation for right shoulder degenerative osteoarthritis, effective from July 30, 2010, to May 18, 2011, and assigned a 20 percent evaluation from May 18, 2011 for that disability. It also granted a 20 percent evaluation from October 6, 2004, and a 40 percent evaluation from July 30, 2010, for the Veteran’s lumbar spine disability. In August 2014, the RO issued a rating decision whereby it effectuated the November 2013 Board decision. Subsequently, in September 2014, the Veteran filed a notice of disagreement with the August 2014 rating decision, contesting the effective dates of the aforementioned awards and seeking an increased evaluation for his right shoulder disability. However, as that rating decision expressly cited to the Board decision and explained that it was implementing the same, the Veteran’s appeal to the RO of the merits of the Board decision was in error. The proper venue for an appeal of the Board decision would have been to the United States Court of Appeals for Veterans Claims (Court), not the RO. See Court’s Rules of Practice and Procedure at 3, 4; see also “Your Rights to Appeal Our Decision,” infra. Notwithstanding the fact that the RO issued a statement of the case in April 2015 on the merits previously adjudicated by the Board in November 2013, and certified these appeals to the Board, the issues are res judicata and not subject to new claims because the November 2013 Board decision was final. 38 C.F.R. § 20.1100. Consequently, the Veteran’s increased rating and earlier effective date claims are dismissed. See also Rudd v. Nicholson, 20 Vet. App. 296 (2006). REASONS FOR REMAND 1. Entitlement to an evaluation in excess of 40 percent prior to February 9, 2015, and in excess of 60 percent from February 9, 2015, for multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome 2. Entitlement to an effective date prior to February 9, 2015, for the award of a 60 percent rating for lumbar spine disability In an April 2015 rating decision, the RO granted entitlement to a 60 percent rating from February 9, 2015, for the Veteran’s service-connected lumbar spine disability. In a May 2015 notice of disagreement, the Veteran requested an increased evaluation as well as earlier effective date for that award. While the record contains a contemporaneous VA examination regarding the Veteran’s lumbar spine disability, the examination does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The February 2015 examination report does not contain passive range of motion measurements/pain on weight-bearing testing. In addition, the Veteran’s earlier effective date claim, is inextricably intertwined with his pending increased rating claim on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). Finally, the record contains VA treatment records most recently dated in February 2017 from Central Alabama VA HCS. On remand, updated VA treatment records from those facilities dated since February 2017 should be obtained and associated with the electronic claims file. See 38 U.S.C. § 5103A(c) (2012); 38 C.F.R. § 3.159(c)(2) (2017); see also Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records pertaining to his service-connected lumbar spine disability from Central Alabama VA HCS for the period from February 2017 to the present. 2. Schedule the Veteran for an examination of the current severity of his multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to multilevel degenerative disc disease and spondylosis of the thoracic/lumbar spine with intervertebral disc syndrome alone and discuss the effect of the Veteran’s lumbar spine disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing the above actions, and any other necessary development, the claims on appeal must be re-adjudicated. If any benefit on appeal remains denied, a supplemental statement of the case must be provided to the Veteran and his attorney. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. D. Deane, Counsel