Citation Nr: 18144668
Decision Date: 10/25/18	Archive Date: 10/24/18

DOCKET NO. 15-46 823
DATE:	October 25, 2018
ORDER
Entitlement to a rating in excess of 20 percent for lumbar spine degenerative joint disease (DJD) with L5 spondylolysis, spondylolisthesis, and intervertebral disc syndrome (IVDS) is denied.
Entitlement to a compensable rating for a right knee scar is denied.
Entitlement to an effective date prior to September 29, 2011, for service connection for radiculopathy of the right lower extremity is denied.
Entitlement to an effective date prior to September 29, 2011, for service connection for radiculopathy of the left lower extremity is denied.
Entitlement to an effective date prior to September 29, 2011, for service connection for a scar of the right knee is denied.
Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS is denied.
Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for postoperative (PO) residuals of right knee surgery with patellofemoral syndrome (PFS) is denied.
Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of left knee surgery with PFS is denied.
Entitlement to a combined rating in excess of 80 percent prior to September 29, 2011 is denied.
FINDINGS OF FACT
1. The Veteran’s lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS has not caused incapacitating episodes and has been manifested by thoracolumbar flexion which is not limited to 30 degrees or less and an absence of ankylosis.  
2.  The Veteran’s right knee scar is not deep, tender or painful but is superficial and asymptomatic.  
3.  The Veteran’s claim for service connection for radiculopathy of the right lower extremity was received on September 29, 2011, and no formal or informal claim was received prior thereto.  
4.  The Veteran’s claim for service connection for radiculopathy of the left lower extremity was received on September 29, 2011, and no formal or informal claim was received prior thereto.  
5.  The Veteran’s claim for service connection for a right knee scar was received on September 29, 2011, and no formal or informal claim was received prior thereto.  
6.  The Veteran did not perfect an appeal from a June 23, 2013, rating decision which granted service connection for radiculopathy of each lower extremity with each being assigned an initial 20 percent disability rating and increased a 10 percent rating for the service-connected low back disorder to 20 percent; and that rating decision granted increases from 10 percent rating to 20 percent rating as of September 29, 2011, PO residuals of right knee surgery with PFS and for PO residuals of left knee surgery with PFS; and all of these were made effective September 29, 2011, date of receipt of claim.  
7.  The June 23, 2013, from which an appeal was not perfected is final in the absence of any clear and unmistakable error, which is not alleged.  
8.  After the June 23, 2013, rating decision but prior to September 29, 2011, there was no communication which could be reasonably interpreted as a claim for an increased rating for the service-connected low back disorder, the PO residuals of right knee surgery with PFS, or the PO residuals of left knee surgery with PFS.  
9.  Prior to September 29, 2011, it was not factually ascertainable that a rating of 20 percent was warranted for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS and there was no unadjudicated claim for an increased rating prior thereto. 
10.  Prior to September 29, 2011, it was not factually ascertainable that a rating of 20 percent was warranted for PO residuals of right knee surgery with PFS, or the PO residuals of left knee surgery with PFS.  
11.  Prior to September 29, 2011, the Veteran’s service-connected disabilities did not combine to an overall disability rating in excess of 80 percent.  
CONCLUSIONS OF LAW
1. The criteria for a rating in excess of 20 percent for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS are not met.  38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237 and 5243 (2017). 
2. The criteria for a compensable rating for a right knee scar are not met.  38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, DC 7805 (2017). 
3. The criteria for an effective date prior to September 29, 2011, for service connection for radiculopathy of the right lower extremity are not met.  38 U.S.C. §§ 5101(a), 5110(a), 7105 (West 2014); 38 C.F.R. §§ 3.104(a), 3.400(b)(2)(i), 20.200, 20.302, 20.1103 (2017). 
4. The criteria for an effective date prior to September 29, 2011, for service connection for radiculopathy of the left lower extremity are not met.  U.S.C. §§ 5101(a), 5110(a), 7105 (West 2014); 38 C.F.R. §§ 3.104(a), 3.400(b)(2)(i), 20.200, 20.302, 20.1103 (2017) (2017). 
5. The criteria for an effective date prior to September 29, 2011, for service connection for a scar of the right knee are not met.  U.S.C. §§ 5101(a), 5110(a), 7105 (West 2014); 38 C.F.R. §§ 3.104(a), 3.400(b)(2)(i), 20.200, 20.302, 20.1103 (2017) (2017).  
6. The criteria for an effective date prior to September 29, 2011, for a 20 percent rating for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS are not met.  38 U.S.C. §§ 5110(a), 5110(b)(2), 7105 (West 2014); 38 C.F.R. §§ 3.104(a),3.400(o)(1), 3.400(o)(2), 20.200, 20.302, 20.1103 (2017) (2017). not been met.  
7. The criteria for an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of right knee surgery with PFS, are not met.  38 U.S.C. §§ 5110(a), 5110(b)(2), 7105 (West 2014); 38 C.F.R. §§ 3.104(a),3.400(o)(1), 3.400(o)(2), 20.200, 20.302, 20.1103 (2017) (2017). 
8. The criteria for an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of left knee surgery with PFS, are not met.  38 U.S.C. §§ 5110(a), 5110(b)(2), 7105 (West 2014); 38 C.F.R. §§ 3.104(a),3.400(o)(1), 3.400(o)(2), 20.200, 20.302, 20.1103 (2017) (2017).  
9. The criteria for a combined rating in excess of 80 percent prior to September 29, 2011, are not met.  38 C.F.R. §§ 4.25, 4.26 (2017). 
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran had active service form January 1979 to February 2000.  
The protracted and complex procedural history of this appeal must be set forth.  Historically, a June 25, 2013, rating decision granted service connection for radiculopathy of each lower extremity effective September 29, 2011 (date of receipt of claim) with each being assigned an initial 20 percent disability rating.  Service connection was granted for a residual scar of the low back (associated with lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS) and initially rated 10 percent, from September 29, 2011.  A 10 percent rating for the service-connected low back disorder was increased to 20 percent effective September 29, 2011 (date of receipt of claim); and a 100 percent temporary total rating, based on surgical or other treatment necessitating convalescence was assigned effective January 11, 2012, with a 20 percent schedular rating being resumed effective April 1, 2012.  Also, 10 percent ratings in effect for tendonitis with PO residuals of surgery on each knee with PFS of each knee, were increased to 20 percent effective September 29, 2011 (date of claim receipt).  In pertinent part, the following ratings were confirmed and continued: 10 percent for status post (SP) bi-correctional head osteotomy of the left 1st metatarsophalangeal (MTP) joint, with residuals; noncompensable (0%) ratings for scars of the left lower extremity; residuals of a left fibular fracture; and a scar of the right knee.  Entitlement to a TDIU rating was denied. 
Three Statements of the Case (SOCs) were issued on June 25, 2015.  
The Veteran did not file a VA Form 9, Appeal to the Board, or equivalent, to perfect appeals of issues addressed in two of three Statements of the Case (SOCs) dated June 25, 2015.  There was one SOC of June 25, 2015, as to which a VA Form 9 was filed, perfecting the appeal of the matters addressed herein.  As to the two SOCs to which a VA Form 9 was not filed, a second SOC of June 25, 2015 addressed service connection for obstructive sleep apnea, and ratings in excess of 20 percent for disabilities of each knee, i.e., SP surgery of each knee with PFS.  The third SOC of June 25, 2015, to which no VA Form 9 was filed, addressed the propriety of reduction of the evaluations of scars of the left lower extremity from 10 percent to a noncompensable rating, and the 20 percent ratings assigned for radiculopathy of each lower extremity.  
Also, an SOC dated June 10, 2015, to which no VA Form 9 was filed addressed an issued described therein as “[y]ou contend VA decision to pay $2,384.00 retroactive benefits for the period October 1, 2011 to July 1, 2013 was improper.”  As no VA Form 9, or equivalent, was filed at to the second, third, and fourth SOCs dated in June 2015, the appeals as to those matters has not been perfected and, so, those matters are not before the Board.  38 C.F.R. §§ 20, 200, 20.202, 20.302(b). 
A December 17, 2015, rating decision granted service connection for a surgical scar of the left foot, secondary to SP bi-correctional head osteotomy of the left 1st MTP joint, which was assigned an initial noncompensable disability rating, effective September 18, 2015.  The Veteran filed a Notice of Disagreement (NOD) on December 31, 2015, as to the initial evaluation assigned and the effective date of that award.  That NOD purported to disagree with a denial of a 100 percent temporary total rating based on convalescence base on left foot surgery of September 22, 2009 (and for which he was reportedly released from a physician in February 2012); however, the December 17, 2015, rating decision adjudicated and granted a temporary total rating based on convalescence effective September 18, 2015, based on left foot surgery in September 2015, and not any prior left foot surgery in September 2009.  The RO has not adjudicated entitlement to a temporary total rating, based on need for convalescence, following any left foot surgery in September 2009.  Thus, there can be no NOD to such matter.  However, as to the initial evaluation assigned and the effective date for service connection for a surgical scar of the left foot, secondary to SP bi-correctional head osteotomy of the left 1st MTP joint, the filing of an NOD initiated an appeal from the December 2015 rating decision.  In Manlincon v. West, 12 Vet. App. 238 (1999), it was held that where an NOD had not been recognized, the proper course was for the Board to remand that pertinent issue for the issuance of an SOC.  However, in this case is does not appear that the RO has failed to recognize the December 31, 2015, NOD and, so, no action is warranted by the Board.  
An April 8, 2016 rating decision denied service connection for right hallux valgus.  Service connection was granted and ratings assigned as of December 18, 2015 for the following: left hip, impairment of the thigh, rated 20percent; right hip, impairment of the thigh, rated 20 percent; limitation of extension of the left hip, rated 10 percent; limitation of extension of the right hip, rated 10 percent; limited left hip flexion, rated noncompensable; limited right hip flexion, rated noncompensable.  Also, basic eligibility was granted for Dependents’ Educational Assistance (DEA) from December 18, 2015.  
Although a May 9, 2016, rating decision denied service connection for hearing loss, and an October 5, 2016 rating decision granted service connection for hypertension, rated 10 percent, from April 26, 2016; a December 1, 2016, rating decision granted service connection for hearing loss, rated 10 percent, and service connection for tinnitus, rated 10 percent, all from April 16, 2016.  The Veteran did not file NODs to the April 8, 2016; May 9, 2016; October 5, 2016; or December 1, 2016 rating decisions.  
On June 13, 2013, the RO made a Formal Finding on the Unavailability of Social Security Administration (SSA) records.  By letter of June 13, 2013, the Veteran was notified that RO attempts to obtain his SSA records had been unsuccessful and that he should submit any copies he had in his possession.  A June 14, 2013, Report of General Information shows that the Veteran reported that he did not have any SSA records and did not know the location of the records.  An undated SSA letter states that in response to a January 15, 2014, request SSA records could not be sent because they did not exist and the Veteran had not filed for disability benefits.  
In a November 2016 Statement of Accredited Representative In Appealed Case, In Lieu of VA Form 646, it was noted that a May 7, 2013, VA examination had found that thoracolumbar flexion was to 45 degrees.  It was asserted that if an increased rating could not be granted that the case should be remanded for an up-to-date VA rating examination because the Veteran alleged that the 2013 rating examination did not accurately portray the current disability picture.  However, the Veteran was afforded a VA rating examination of the Veteran’s thoracolumbar spine in June 2014.  Nevertheless, the request for an additional VA rating examination was renewed by the Veteran’s service representative in a May 29, 2018, Appellant’s Brief.  
However, entered into VBMS on January 5, 2018, is a record which reflects that the Veteran was scheduled for a VA thoracolumbar examination but that on January 5, 2018, he declined to attend the examination because he was already in receipt of a 100 percent combined disability evaluation.  
A January 32, 2018, VA Form 27-0820, Report of Contact, reflects that the Veteran was contacted telephonically to confirm that he wished to cancel his scheduled examinations.  The Veteran stated that he did not want the examinations scheduled because he did not want his service connected issues reevaluated.  He stated that he filed the claim but he did not realize that his claim for chronic pain syndrome would re-address the already service connected disabilities.  It was explained to him that his claim for depression would also cause a re-evaluation his service connected PTSD.  The Veteran understood and agreed that he did not want his claims to be processed.  He was informed that he would receive a letter stating that his claims were withdrawn.  
By RO letter of January 24, 2018, the Veteran was informed that the RO had discontinued action on his claims for major depression, claimed as secondary to PTSD and chronic pain syndrome, claimed secondary to you service connected hips, spine, knees/lower extremities/tendonitis, and status post bi-correctional head osteotomy.  If he did not intend to withdraw his claims, as listed, he had 30 days from the date of the letter to provide the RO with that information.  He did not do so.  
This appeal is comprised of documents contained in the Veterans Benefits Management System (VBMS) and the Virtual VA system.  All future documents should be incorporated into the Veteran's VBMS file.  
Background
Received on November 18, 1999, prior to service discharge, was the Veteran’s VA Form 21-526, Application for Compensation or Pension, and in an attachment, he set forth multiple claims including tendonitis in each knee and residuals of surgery for each knee, and for a low back disorder with a herniated disc.  
On official examination on December 8, 1999, the Veteran was examined for bilateral knee pain, a back disorder, and a history of fracture of the right lower fibula.  He had had right knee surgery in November 1995 and left knee surgery in April 1996.  He related that his back disorder began after a bad parachute jump in 1983 and had had symptoms for about a year, and was told he had a bulging disc “or something similar.”  But, in 1984 his back was symptom free, until he had surgery on his knees following which his back symptoms recurred.  
On physical examination the Veteran’s sensations were intact, and he was without any tingling or numbness, and motor function was 5/5 in all muscle groups.  Deep tendon reflexes (DTRs) were 2+, bilaterally, at the knees and ankles.  Anterolaterally, there was a 7 cms. scar on the left knee and a 5 cms. scar on the right knee.  His posture and gait were normal.  He could fully bend and squat.  There was no paravertebral muscle tenderness and normal spinal curvature.  Straight leg raising (SLR) was negative, bilaterally.  As to the lumbar spine flexion was to 95 degrees, extension as well as right and left rotation were to 35 degrees, and right and left lateral bending were to 40 degrees.  There was no atrophy of the lower extremities.  Knee flexion was to 140 degrees, with pain at 100 degrees, and extension was full to 0 degrees, bilaterally.  Drawer’s and McMurray’s tests were negative, bilaterally.  He had moderate pain on the medial aspect of the femoral joints.  He had moderate tendonitis of the knees.  X-rays revealed bilateral pars interarticularis defect of Grade 2 anterior spondylolisthesis of L5-S1, and mild degenerative disc disease (DDD) was suspected at L5-S1 and to a lesser extent at L4-5.  X-rays revealed no abnormality of either knee.  The diagnoses were (1) bilateral knee condition, no pathology; (2) low back condition, spondylolisthesis with degenerative joint disease (DJD); and (3) residuals of right fibula fracture, no pathology.  
A March 1, 2000 rating decision granted service connection for lumbosacral (LS) DJD, rated noncompensably (0%) disabling; left fibula fracture residuals, rated noncompensably (0%) disabling; right knee tendonitis, rated 10 percent; left knee tendonitis, rated 10 percent; all effective March 1, 2000 (the day after service discharge).  This resulted in a combined disability rating of 20 percent.  The Veteran was notified of this rating decision by RO letter of March 21, 2000.  
The Veteran’s Notice of Disagreement (NOD) as to the 10 percent ratings assigned for each knee and noncompensable rating for lumbosacral DJD was received on April 4, 2000.  He made no reference to having any radicular symptoms in his lower extremities.  
An RO letter of April 13, 2000, acknowledged the Veteran’s appeal and requested that he submit any additional evidence he might have.  
A June 21, 2000 rating decision described the Veteran’s service-connected low back disorder as a lumbar spine condition, including L5 spondylolysis, spondylolisthesis, and DJD, and assigned a 10 percent rating retroactively to March 1, 2000 (day after service discharge).  This resulted in there being a combined disability evaluation of 30 percent, including a bilateral factor of 1.9 percent, effective March 1, 2000.  The Veteran was notified of this decision by letter of June 29, 2000.  
On June 29, 2000, a Statement of the Case (SOC) was issued addressing the 10 percent ratings for right knee tendonitis, left knee tendonitis, and the low back disorder.  
 However, the Veteran never perfected his appeal by filing a Substantive Appeal, VA Form 9 or equivalent.  
VA outpatient treatment (VAOPT) records show that on August 16, 2001, the Veteran was issued replacement hinged braces for his knees.  

Received on November 4, 2009, was a VA Form 21-4138, Statement in Support of Claim, in which the Veteran requested in increased ratings for his service-connected disorders of each knee.  He also made reference to disabilities of his feet and some of his toes.  At that time, he submitted clinical records in 2009 from Cape Fear Podiatry Associates which includes a July 24, 2009 evaluation that revealed, in pertinent part, that on neurologic evaluation his sensations in his feet were intact, his gait pattern was stable, and he had intact Achilles and patellar DTRs.  
Subsequently received in May 2010 were records of 2009 and 2010 of the Pinnacle Family Care which included, in pertinent part, a report of a February 12, 2010 examination that found that overall DTRs and sensation were intact.  
Received on May 17, 2010 were additional records of Cape Fear Podiatry Associates in 2009 and 2010.  In pertinent part, an October 9, 2009, evaluation noted that the Veteran reported that over the years his left knee condition had improved.  
On VA examinations on March 3, 2011, the Veteran had complaints relative to his feet but these did not include complaints of radicular pain.  Overall, his gait and propulsion were normal.  On examination of his knees he reported that his left knee had progressively worsened and he had constant left knee pain, but there had been no significant change as to his right knee which was stable.  He used bilateral hinged knee braces intermittently but frequently.  He had had inservice patellar tendon repair of the right knee in 1995 and of the left knee in 1996.  As to his left knee he complained of giving way, instability, pain, stiffness, and weakness but no locking, dislocations or subluxations.  He reported having severe weekly flare-ups lasting for hours, precipitated by prolonged walking and alleviated by resting and applying ice.  He has similar complaints as to his right knee except that he did not complained of stiffness or weakness; and he had no locking, dislocations or subluxations.  He reported having moderate flare-ups every 1 to 2 months lasting for hours, precipitated by prolonged walking and alleviated by resting and applying ice.  He reported he could stand for more than 1 hour but less than 3 hours.  
On physical examination the Veteran’s gait was normal.  He had two vertical surgical scars of the right knee which were asymptomatic.  He had tenderness of the right patellar tendon and at the lateral joint space but no crepitation, grinding, instability or abnormality of the patella or meniscus.  
As to his left knee, the examination found tenderness, weakness, abnormal motion, and guarding of movement.  There was a surgical left knee scar as to which the Veteran complained of tenderness and numbness but which was otherwise asymptomatic.  There was edema and tenderness all around the left patella, most significantly at the lateral joint space.  There was mild weakness, with strength in flexion and extension being 4/5, due to pain.  There was no grinding or instability or meniscus abnormality.  He had subpatellar tenderness and tenderness of the patellar tendon.  Flexion was to 130 degrees on the right and 100 degrees on the left with extension being normal, bilaterally.  He had pain on repetitive motion but without additional limitation of motion after 3 repetitions of motion.  
With respect to a past right fibular fracture, the examination found decreased sensation to pinprick and soft touch in an area that was 6 cms. long along the mid-anterior region of the right tibia and 4 cms. wide medial to the anterior right tibia, and he complained of tenderness to palpation of that area.  The examiner noted that this was not consistent with a past fibular fracture.  
A July 11, 2011, addendum clarified that the Veteran had not had an inservice fracture of the right fibula but an inservice fracture of the right tibia.  

In pertinent part, an August 18, 2011, rating decision granted service connection for a scar of the right knee which was assigned an initial noncompensable rating, all effective November 4, 2009 (date of receipt of claim).  The 10 percent ratings for tendonitis of the left knee and for tendonitis of the right knee were confirmed and continued.  Together with grants of service connection for scars of the left lower extremity, rated 10 percent and SP bi-correctional head osteotomy of the left 1st metatarsophalangeal (MPT) joint rated 10 percent, this resulted in an increase of the combined rating from 30 percent to 40 percent, effective November 4, 2009.  
The Veteran was notified of that decision by RO letter of August 22, 2011.  
Received on August 30, 2011, was a VA Form 21-4138, Statement in Support of Claim, dated August 26, 2011, in which the Veteran addressed the rating for his service-connected low back disorder which should result in his having a higher combined rating.  This correspondence bears a handwritten notation (made by RO personnel) of “not valid NOD.”  
An undated VA Form 21-0820, Report of Contact, reflects that the Veteran was contacted to clarify what he was attempting to appeal.  It further stated that it was explained to him that his notification letter addressed only the issues in his new [August 18, 2011] rating and not the ratings for all of his service-connected disorders.  It was explained to him that for compensation purposes his service-connected disorders were not simply added together but were combined [under a combined ratings schedule].  The Veteran stated that he understood and did “not desire to file an appeal.”  
A September 29, 2011, rating decision denied reopening of a claim for service connection for residuals of a fracture of the right tibia, previously claimed as right leg pain, because new and material evidence had not been submitted.  It was noted that a final March 2000 rating decision had found that the Veteran’s inservice right leg pain was acute and transitory and there was no residual disability.  The Veteran was notified of the September 29, 2011, rating decision by RO letter of that same date.  The Veteran did not appeal that decision.  
Entered into VBMS on September 29, 2011, is VA Form 21-4138, Statement in Support of Claim, dated September 6, 2011, in which the Veteran stated he was supporting his claim for “fracture right tibia/fibula” as right leg pain.  He reported that he had not leg problems prior to military service but only after Airborne School did he start to have problems with his lower legs.  He had pain when walking, climbing stairs, and lacing his boots.  The inner side of his legs were always painful.  Over the years pain and tenderness of his lower right leg had continued.  He believed that trauma from his inservice parachute jumps was the cause of his problems with his back, knee, leg, and feet; and these conditions had existed since his miliary service until the present time.  
Entered into VBMS on February 26, 2012, was the Veteran’s VA Form 21-4138, Statement in Support of Claim, dated February 22, 2012, in which the Veteran requested an increased rating for his service-connected lumbosacral disorder in excess of the current 10 percent disability rating.  He reported having localized low back pain as well as pain in buttocks, hamstrings, thighs, and legs.  He had pain and numbness in his lower extremities, and occasional problems with bowel and bladder control.  He had undergone extensive treatment for his low back disability and had seen a neurosurgeon.  He had had low back surgery on January 11, 2012, but continued to have pain and significant limitations, including using a back brace and a cane at work.  
Entered into VBMS on February 29, 2012, were private clinical records of 2011 and 2012.  An October 11, 2011, clinical record shows that the Veteran reported that the Veteran complained of having had constant sharp pain in the left and right low back regions and the mid-line of the low back.  This symptom had started two weeks ago.  It moderately limited his activity.  The pain radiated down both legs.  On examination he had tenderness of the lumbar spine and SLR was positive on the right.   An October 11, 2011, lumbar MRI revealed Grade 1 to II anterolisthesis of L5 on S1 with associated degenerative disc disease (DDD) and facet arthropathy at L5-S1 contributing to symmetric neural foraminal canal stenosis. The was a bilateral pars defect at L5, consistent with bilateral spondylolysis; there were multi-factorial degenerative changes at L4-5 resulting in mild symmetric neuroforaminal narrowing.  
Another private clinical record shows that on October 19, 2011 the Veteran reported having had low back for many years, which had worsened in the past week.  On physical examination he had severely limited lumbar motion, with painful motion and paravertebral muscle spasm.  SLR was positive on the right.   There was decreased sensation in the right lower extremity to light touch in the L4-5 dermatome, and DTR at the right ankle reflex was absent.  The assessment was low back pain and spondylolisthesis.  Another private clinical record shows that on October 24, 2011 the Veteran reported having had low back for many years, which had worsened in the past week.  Pain radiated into the right lower extremity.  On examination there was severely limited lumbar motion, with pain on motion and paravertebral muscle spasm.  SLR was positive on the right.  There was decreased sensation in the right lower extremity to light touch in the L4-5 dermatome.  DTR was absent at the right ankle.  
When seen on November 8, 2011, at the Carolina Neurosurgical Services straight leg raising (SLR) was negative at 90 degrees, bilaterally.  He had had prior knee surgeries, so he had an absent right ankle jerk and a 1+ left ankle jerk.  He had good motor strength in all muscle groups in his lower extremities.  A November 23, 2011, lumbar CT scan found Grade 2 anterior spondylolisthesis of L5 on S1, and bilateral spondylolysis at L5 but no evidence of disc bulging, focal disc herniation or central canal stenosis.  At L4-5 there was mild broad-based disc bulging with mild bilateral degenerative facet joint disease and a small superimposed left lateral disc protrusion.  There was no evidence of lumbar scoliosis.  Lumbar X-rays revealed similar findings, including disc space narrowing indicative of DDD at L5-S1.  
Also submitted at that time was a January 11, 2012 operative report showing that the Veteran had a decompressive laminectomy at L5-S1, bilateral S1 foraminotomies, partial open reduction of L5-S1 spondylolisthesis and posterolateral instrumentation and fusion at L5-S1.  
The Veteran’s VA Form 21-8940, Application for Increased Compensation Based on Unemployability, was dated and received May 3, 2012.  He reported that he had become too disabled to work and had last worked on December 11th.  However, he also reported working as a civilian for the U.S. Army, Department of Defense, from May 2007 to the present.  
Of record is a June 19, 2012, statement that the Veteran was currently employed with the U.S. Government, at Ft. Bragg, Network Enterprise Center but due to spinal surgery he had spent a lot of time out of work, according to medical advice.  By medical advice he was not to engage in constant walking or standing, lifting or carrying over 5 lbs., no bending, reaching or twisting and no climbing stairs or ladders but each of these tasks was often required in his employment position.  
A June 20, 2012, VA Form 21-4192, Request for Employment Information In Connection with Claim for Disability Benefits, reflects that the Veteran was employed as an “IT Specialist (Network)” and had been since May 14, 2007.  
Lumbar spine X-rays by Carolina Imaging were taken on August 27, 2012, after the Veteran fell the previous Thursday.  They revealed Grade 1-2 anterolisthesis of L5 on S1; and mild degenerative changes at L3-4 and L4-5, but no evidence of a fracture.  
The Veteran underwent multiple official examinations on May 7, 2013.  
On official scar examination of May 7, 2013, it was noted that the Veteran had scars from bilateral knee surgery, a left bunionectomy, and lumbar spine surgery.  The Veteran reported that he had pain at his low back scar.  None of the scars was both painful and unstable.  None of the scars was unstable, i.e., with frequent loss of covering of skin over the scar.  He had a 1.4 cms. scar on the anterior aspect of the right knee and a 2.2 cms. scar on the anterolateral aspect of the right knee, both of which were linear.  He had a 15 cms. linear scar on his low back.  He had a scar on the anterior aspect of the left knee and the dorsum of the left great toe, and each was linear and 6 cms. in length.  None of the scars caused limitation of function.  
On official examination of May 7, 2013, of the Veteran’s knees it was reported that the Veteran had had surgery on each knee and had PFS as well as tendonitis of each knee.  The Veteran reported having had inservice stress fractures of the left fibula and right tibia from parachute jumps.  The Veteran reported having flare-ups that impact function of his knees causing pain and stiffness.  His gait was antalgic due to his knees.  
On physical examination the Veteran had pain on right knee flexion at 85 degrees, with flexion being to 90 degrees but he had full and painless extension to zero (0) degrees.  He had pain on left knee flexion at 85 degrees, with flexion being to 90 degrees but he had full and painless extension to zero (0) degrees.  There was no change in his ranges of motion in either knee after 3 repetitions of motion.  He had functional loss or impairment in each knee due to limited and painful motion, as well as disturbance of locomotion.  He had no tenderness of pain to palpation of the joint lines or soft tissues of the knees.  Strength was full, at 5/5, in each knee and there was no joint instability or evidence or history of recurrent patellar subluxations.  It was reported that he had a meniscus condition of each knee with frequent episodes of joint pain and frequent episodes of joint effusion in each knee, but he had never had a meniscectomy.  His past knee surgeries had been a 1995 repair of the right patellar tendon and a 1996 repair of the left patellar tendon.  He reported that since that surgery he had had pain, weakness, stiffness, and swelling.  None of his surgical knee scars were painful or unstable, and the total area of involvement was not 39 square cms.  He constantly used bilateral knee braces and constantly used a cane as an ambulatory aid.  X-rays had not documented either degenerative or traumatic arthritis of either knee, nor patellar subluxation.  The examiner opined that the Veteran’s knee disorders prevented him from performing physical activities but that he could tolerate sedentary activities.  
On official examination of May 7, 2013, of the Veteran’s thoracolumbar spine it was reported that he had lumbar DJD, and bilateral IVDS at L4-S3 nerve roots, affecting the sciatic nerve.  He had been treated in the past with epidural injections, and had had spinal surgery.  
On physical examination the Veteran had pain on thoracolumbar flexion at 40 degrees, with flexion being to 45 degrees, and he had pain on extension at 5 degrees, with extension being to 10 degrees.  He had pain on right and left lateral bending at 15 degrees, with each motion being to 20 degrees.  He had pain on right and left rotation at 15 degrees, with each motion being to 20 degrees.  There was no change in the complete range of motion in each plane after 3 repetitions of motion.  He had function loss or impairment due to limited and painful motion.  He had paraspinal muscle tenderness but no spasm or guarding.  Testing of muscle strength from the hips to the toes was normal and there was no muscle atrophy.  DTRs and sensations in the lower extremities were normal.  SLR was negative, bilaterally.  He did have signs of radiculopathy consisting of moderate intermittent pain and moderate paresthesias or dysesthesias in each lower extremity but no numbness or constant pain.  This caused moderate sciatic nerve radiculopathy in each lower extremity.  He had no other neurologic findings, e.g., bowel or bladder dysfunction.  He had IVDS but had not had any incapacitating episodes in the past 12 months.  He used braces and a cane for his back and knees.  His low back surgical scar was not painful or unstable and the total area of involvement was not 39 square cms.  The examiner opined that the Veteran’s knee disorders prevented him from performing physical activities but that he could tolerate sedentary activities.
A report of an evaluation at the Pinnacle Family Care on May 14, 2013, shows that that Veteran had an antalgic gait, to the left.  His sensations were grossly intact.  Reflexes were 2+ throughout.  There was a normal curvature of his thoracolumbar spine.  
A lumbar MRI by Carolina Imaging on May 15, 2013, revealed bilateral fixation at L5-S1 with associated metal artifact; Grade 1-2 anterolisthesis of L5 on S1; broad-based disc bulging at L3-4, L405, and L5-S1 without disc herniation.  
A lumbar myelogram at the Moore Regional Hospital on June 12, 2013, revealed the prior posterior fusion of L5-S1; and Grade 2 spondylolisthesis of L5 on S1, and negative findings as to the neural foraminal or central spine canal narrowing.  
A June 25, 2013, rating decision granted service connection for radiculopathy of each lower extremity effective September 29, 2011 (date of receipt of claim) with each being assigned an initial 20 percent disability rating.  Service connection was granted for a residual scar of the low back (associated with lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS) and initially rated 10 percent, from September 29, 2011.  A 10 percent rating for the service-connected low back disorder was increased to 20 percent effective September 29, 2011 (date of receipt of claim); and a 100 percent temporary total rating, based on surgical or other treatment necessitating convalescence was assigned effective January 11, 2012, with a 20 percent schedular rating being resumed effective April 1, 2012.  Also, 10 percent ratings in effect for tendonitis with PO residuals of surgery on each knee with PFS of each knee, were increased to 20 percent effective September 29, 2011 (date of claim receipt).  In pertinent part, the following ratings were confirmed and continued: 10 percent for status post (SP) bi-correctional head osteotomy of the left 1st metatarsophalangeal (MTP) joint, with residuals; noncompensable (0%) ratings for scars of the left lower extremity; residuals of a left fibular fracture; and a scar of the right knee.  Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU rating) was denied. 
This resulted in an increase in the combined disability rating of 40 percent, which had been in effect since November 4, 2009, to 80 percent effective September 29, 2011; with a 100 percent rating under 38 C.F.R. § 4.30 (convalescent rating) from January 11, 2012 (date of lumbosacral surgery); and an 80 percent combined rating was resumed effective April 1, 2012 (upon expiration of the 100 percent convalescent rating).  The Veteran was notified of this rating decision by RO letter of June 27, 2013.  
The Veteran’s NOD was received on July 12, 2013 as to the 20 percent disability rating for his service-connected low back disorder; the noncompensable rating for his right knee scar (alleging that a left knee scar was rated 10 percent, and so should the right knee scar); and the ratings for his service-connected knee disabilities.  
The Veteran has submitted records of his having to use leave, including sick leave, from his employment.  
An August 15, 2013, report of an evaluation of the Veteran at the Sandhills Physical Medicine and Rehabilitation shows that his low back pain had not responded to past physical therapy or chiropractic manipulations.  He was given a set of left lumbar medial branch block injections.  
An August 29, 2013, report of an evaluation of the Veteran at the Sandhills Physical Medicine and Rehabilitation shows that he reported that past left lumbar medial branch blocks had not been helpful.  He complained of lumbar pain and pain in his thighs above the knees which was not in a radicular pattern.  An examination was negative for numbness and tingling, as well as for muscle weakness and joint swelling.  SLR was negative, bilaterally.  He had a gentle lumbar lordotic curvature without gross scoliosis or other abnormal spinal curvatures.  There was tenderness over the lumbar facet joints on the left.  He had full active range of motion of all major joints.  He had a slow and cautious gait with the use of a single point cane.  There was no laxity or subluxation of the major joints.  
A January 23, 2014, VA Form 21-4192, Request for Employment Information In Connection with Claim for Disability Benefits, reflects that the Veteran was employed full-time as an “IT Specialist (Network)” and had been since May 14, 2007.  Concessions made by o disability due to difficulty standing, bending, walking, lifting, and climbing stairs and ladders.  
On official examination on June 24, 2014, of the Veteran’s knees he reported that flare-ups impacted function of his knees causing him to be unable to stand, walk or climb stairs.  On physical examination the Veteran had right knee pain beginning at 90 degrees with flexion being to 100 degrees and full painless extension to zero (0) degrees.  He had left knee pain beginning at 90 degrees with flexion being to 100 degrees and full painless extension to zero (0) degrees.  There was no change in range of motion after 3 repetitions of motion.  He had functional loss or impairment in each knee due to limited and painful motion and excess fatigability.  He did not have tenderness or pain to palpation of the joint lines or soft tissues of the knee.  He had full strength in each knee in flexion and extension.  Joint stability tests were all normal.  There was no evidence or history of recurrent patellar subluxation or dislocation.  He did not have any menisceal conditions, and had not had a meniscectomy.  The Veteran reported having swelling of his knees since his surgeries in 1995, on the right, and 1996, on the left knee.  On examination he had scars of the knees but they were not painful or unstable, and the total area of the scars was not greater than 39 square cms.  The length and width of the knee scars was, on the lateral right knee 5 x .5 cms. And the anterolateral left knee of 2 x 0.5 cms.  He constantly used a cane.  X-rays had not confirmed either degenerative or traumatic arthritis, or evidence of patellar subluxation.  The examiner stated that the impact of the knee conditions on the Veteran’s ability to work was that he was unable to do extended walking.  
On official examination on June 24, 2014, of the Veteran’s thoracolumbar spine the Veteran reported having had spinal fusion surgery in 2012.  He reported that flare-ups caused low back pain which went down the hips, knees, ang legs.  His posture was within normal limits but his gait was antalgic due to his knees.  On examination thoracolumbar flexion caused pain at 35 degrees but motion continued to 40 degrees.  Pain began at 5 degrees of extension but continued to 10 degrees.  Right and left lateral bending caused pain at 10 degrees with motion continuing to 15 degrees.  Right and left rotation caused pain at 10 degrees with motion continuing to 15 degrees.  He was able to perform 3 repetitions of motion, after which there was no change in the limits of his ranges of motion.  He had functional loss or impairment due to limited and painful motion and excess fatigability, as well as interference with sitting, standing and/or weight-bearing.  He did not have localized tenders or pain to palpation of the joints and/or soft tissues.  Here was no thoracolumbar guarding or muscle spasm.  Muscle strength and reflexes were normal in all lower extremity joints, and there was no muscle atrophy.  Sensations were all normal in the lower extremities.  SLR was positive, bilaterally.  He did have signs of radiculopathy consisting of moderate intermittent pain and moderate paresthesias or dysesthesias in each lower extremity but no numbness or constant pain.  This caused moderate sciatic nerve radiculopathy in each lower extremity.  He had no other neurologic findings, e.g., bowel or bladder dysfunction.  He had IVDS but had not had any incapacitating episodes in the past 12 months.  He constantly used a cane as an ambulatory aid.  X-rays documented thoracolumbar arthritis but there was no vertebral fracture.  As to impacting his work, the examiner stated that the Veteran was unable to sit or stand for extended periods of time.  
A July 15, 2014, rating decision reduced a 10 percent rating for a left knee surgical scar, SP tendon repair, to a noncompensable rating, effective June 24, 2014 (date of official examination).  Twenty (20) percent ratings were confirmed and continued for tendonitis of the left knee, SP surgery, with PFS; radiculopathy of the left lower extremity; and radiculopathy of the right lower extremity.  Service connection for obstructive sleep apnea was denied.  
Entered into VBMS on July 21, 2014, is an undated and unsigned “Back (thoracolumbar) Conditions” Disability Benefits Questionnaire (DBQ) submitted by the Veteran.  It does not bear the signature of any clinician and does not contain any clinical findings.  It reflects that the Veteran reported that the impact of flare-ups and his functional loss and impairment were trouble walking, standing, sitting, bending, and sleeping.  
On official examination of the Veteran’s knees on September 3, 2014, as reported in Knee and Lower Leg Conditions DBQ shows that the Veteran reported that flare-ups caused his knees to become swollen and very painful, with difficulty standing and lateral movement.  On examination he had full and painless right knee flexion and extension.  In the left knee he had full and painless extension but in flexion pain began at 130 degrees, although flexion was full to 140 degrees.  There were no changes in the ranges of motion after 3 repetitions of motion.  He had functional loss or impairment due to painful motion of the left knee.  There was no tenderness or pain to palpation for joint line or soft tissues of either knee.  He did not have tenderness or pain to palpation of the joint lines or soft tissues of the knee.  He had full strength in each knee in flexion and extension.  Joint stability tests were all normal.  There was no evidence or history of recurrent patellar subluxation or dislocation.  He did not have any menisceal conditions, and had not had a meniscectomy.  The scars of his knees were not painful or unstable.  There were contributing factors of pain, weakness, fatigability and/or incoordination but no additional limitation of functional ability of the knee joints during flare-ups or repeated use over time.  Left knee X-rays revealed a punctuate artifact overlying the proximal left fibula.  There was no evidence of joint effusion, acute fracture or dislocation.  
In VA Form 21-4138, Statement in Support of Claim, dated March 3, 2015 the Veteran reported that on July 18, 2014, he had filed a claim for increased compensation for his left knee, his low back, and degenerative joint disease of the hips.  He also stated that while the RO was addressing a claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU rating) he had not filed such a claim and was he was employed as a civilian with the U.S. Army and that his job/position “has addressed all my physical limitations and disabilities.”  
In a May 11, 2015, statement the Veteran reported that following his low back surgery he needed assistance putting on his shoes, although he could function daily.  
In June 2015 the Veteran submitted color photographs, one of which depicts his low back surgical scar. 
VA Form 21-4192, Employment Information In Connection With Claim for Disability Benefits of June 2015 shows that the Veteran had been employed full—time as an information technology specialist with the U.S. Arm since May 2007.  He had used 140 hours of sick leave in the past 12 months due to disability.  Concessions made at work due to age or disability were difficulty standing, bending, twisting, lifting, and climbing stairs and ladders.  
In July 2015 the Veteran submitted color photographs, two of which appear to depict his knees.  
A July 13, 2015, VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ) reflects that no medical records were reviewed.  The Veteran reported having had pain and swelling which had worsened since 1996 after right knee surgery for tendonitis and PFS.  He reported that flare-ups caused problems walking, standing, shifting weight, and lateral movement.  He reported having functional loss or impairment with respect to standing and lateral movement.  
On physical examination there was full extension of each knee but flexion was to 110 degrees in the right knee and 130 degrees on the left.  He had pain on all motions but no pain on weight-bearing.   He had localized tenderness or pain on palpation of the right knee but not the left knee.  There was no crepitus in either knee.  While he had pain in each knee it did not result in or cause functional loss.   He could perform repetitive-use testing but there was no additional loss of function or range of motion after three repetitions.   Pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time in the right knee due to pain but not the left knee with there being an additional 10 degrees of limited flexion, i.e., with flexion limited to only 100 degrees.  However, pain, weakness, fatigability or incoordination significantly limited functional ability with flare ups in the left knee due to pain but not the right knee.  Limited right knee motion caused disturbance of locomotion and interference with standing.  Strength was normal in each knee and there was no muscle atrophy.  There was no history of recurrent subluxation or lateral instability in either knee.  There was no joint instability in either knee.  He had not had recurrent patellar dislocations.  He had no menisceal condition in either knee.  He had had a right knee tendon repair in 1995 and a left knee tendon repair in 1996.  He had a right knee scar which was 6 cms. In length and 0.5 cms. In width.  He occasionally used knee braces.  His knee disabilities impacted his ability to work due to pain with prolonged walking, running, kneeling, and squatting. 
A September 8, 2015, rating decision granted service connection a psychiatric disorder characterized as other trauma and stressor related disorder, and assigned an initial evaluation of 30 percent, all effective April 23, 2015.  However, the combined disability rating remained at 80 %, including a bilateral factor of 6.3 percent, effective since April 1, 2012.  
Received in December 2015 was a May 2013 lumber MRI from Carolina Imaging which revealed that the Veteran had a history of lumbar spine surgery in January 2012.  The current imaging was compared to X-rays in 2011 and 2012 as well as prior MRIs in October and November 2011.  There was a persistent Grade 1 – 2 anterior spondylolisthesis of L5 on S1; status post bilateral posterior fixation of the L5-S1 level with associated metallic artifact present; disc space narrowing at L5-S1 consistent with DDD.  There was broad based disc bulging at L3-4 and L4-5 without focal herniation.  
Received in December 2015 were reports from the Sandhill Physical Medicine and Rehabilitation of August 15th and 29th 2013.  When seen on August 15, 2013, it was reported that the Veteran had not responded well to medical management and he now received a “1st left set of lumbar medial branch blocks” because he had degenerative lumbar facets joints with back and leg pain in a typical pattern for facet arthropathy.  On August 29th it was noted that he continued to complain of lumbar spine pain and pain in both thighs above the knees but not in a radicular pattern.  His intensity of pain was unchanged since his last visit and, so, it was reported that the left lumbar medical branch blocks had not been helpful.  On examination there was no muscle weakness.  Straight leg raising was negative, bilaterally.  There was a gentle lumbar lordotic curve but there was tenderness over the lumbar facets on the left.  There was full active range of motion of all major joints.  His gait was slow and cautious, with the use of a single point cane.  There was no gross scoliosis or abnormal spinal curvatures.  There was no laxity or subluxation of the major joints.  
A December 17, 2015, rating decision granted service connection for a surgical scar of the left foot, due to bi-correctional head osteotomy of the left 1st metatarsophalangeal joint which was assigned an initial noncompensable evaluation, all effective September 18, 2015.  A temporary total rating of 100 percent based on need for convalescence was granted effective September 18, 2015; and special monthly compensation (SMC) based on housebound criteria was granted from September 18, 2015, to December 1, 2015; and a 10 percent schedular rating was assigned effective December 1, 2015.  This result in an increase in the combined disability evaluation of 80 percent (which had been effective since April 1, 2012) to 100 percent from September 18, 2015 and 80 percent from December 1, 2015.  
Following VA examinations of the Veteran’s hips on January 14, 2016, an April 8, 2016, rating decision granted service connection for “left hip, impairment of thigh” which was assigned an initial 20 percent rating; granted service connection for “right hip, impairment of thigh” which was assigned an initial 20 percent rating; granted service connection for “left hip, limitation of extension” which was assigned an initial 10 percent rating; granted service connection for “right hip, limitation of extension” which was assigned an initial 10 percent rating; granted service connection for “left hip, limitation of flexion which was assigned an initial 10 percent rating; granted service connection for “right hip, limitation of flexion which was assigned an initial 10 percent rating; and granted basic eligibility to Dependents’ Educational Assistance (DEA); all effective December 18, 2015.  This resulted in an increase of the 80 percent combined disability rating (in effect since December 1, 2015) to 100 percent effective December 18, 2015.   
Records of Pinnacle Family Care from 2011 to 2016 were received in August 2016.  These reflect treatment for multiple disabilities, including back pain and hypertension.  An October 11, 2011, treatment record shows that the Veteran presented with lower back pain which was of sudden onset.  The symptom had started 2 weeks ago.  Activity of bending, exertion, position changes and standing were important triggers.  The symptom was exacerbated by exertion and position changes.  The pain radiated down both legs.  On examination there was tenderness over the lumbar spine and SLR was positive on the right.  In August 2012 he complained of that an aching low back pain was worsening and radiating over the entire back and pelvis.  The symptom was of sudden onset and started 4 days ago.  The mechanism of injury was a fall off of a chair at work, and he was concerned because he had just had lumbar surgery in January 2012.  He denied loss of control of bowel or bladder.  On examination he had tenderness over the lumbar spine, and decreased range of motion in all lumbar planes but without any description of the exact ranges of motion.  He had a stooped stance and an antalgic gait.  
Records of Pinnacle Family Care show that in 2016 the Veteran was treated on multiple occasions for low back pain.  
An October 5, 2016, rating decision granted service connection for hypertension which was assigned an initial 10 percent disability rating, effective April 26, 2016.  That rating decision reflects a notation that “[a] review of the folder indicates that the RD dated 05/09/16 (s/c was deferred; and denied) was not promulgated; and the case was returned for review and a new rating decision.”  This rating decision made no change in the combined disability rating of 100 percent which had been made effective December 18, 2015.
General Rating Principles
Ratings for a service-connected disability are determined by comparing current symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based as far as practical on average impairment in earning capacity.  Separate diagnostic codes identify the various disabilities which are viewed, and examinations are interpreted, historically, to accurately reflect the elements of disability present.  A higher rating is assigned if it more nearly approximates such rating.  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.21. 
Separate ratings may be assigned either initially or during any appeal for an increased rating for separate periods of time based on facts found, a practice known as "staged ratings."  Fenderson v. West, 12 Vet. App. 119 (1999) (initial staged ratings).  Also, the alleviating effects of medication may not be considered in schedular ratings unless explicitly provided in the applicable schedular rating criteria.  Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).  
Reasonable doubt will be favorably resolved and it exists when there is an approximate balance of positive and negative evidence.  It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility.  38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.  If the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable.  Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed.Cir. 2001).
1.  Entitlement to a rating in excess of 20 percent for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS
Under the Diagnostic Code (DC) 5243, intervertebral disc syndrome (IVDS) is rated either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations, whichever method results in the higher rating.  See Bierman v. Brown, 6 Vet. App. 125 (1994).  However, assigning separate ratings for combination may not be permitted to result in pyramiding under 38 C.F.R. § 4.14 - which prohibits "[t]he evaluation of the same disability under various diagnoses".  See Brady v. Brown, 4 Vet. App. 203, 206 (1993).  See, too, Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (the critical element is if symptoms of one condition are duplicative of or overlapping of another).  Thus, a rating for IVDS may not be assigned while at the same time assigning separate ratings for the orthopedic and the neurologic components of IVDS. 
As to incapacitating episodes, if there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent rating is warranted.  If there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted.  If there are incapacitating episodes having a total duration of at least six weeks during the past 12 months, a maximum 60 percent rating is warranted.  The revised IVDS rating criteria do not provide for an evaluation in excess of 60 percent on the basis of the total duration of incapacitating episodes. 
Note 1 to the revised DC 5293 defines an incapacitating episode as a period of acute signs and symptoms that requires bed rest prescribed by and treatment by a physician.  Supplementary Information in the published final regulations states that treatment by a physician would not require a visit to a physician's office or hospital but would include telephone consultation with a physician.  If there are no records of the need for bed rest and treatment, by regulation, there are no incapacitating episodes.  67 Fed. Reg. 54345, 54347 (August 22, 2002).  
Although the appellant's neurological symptoms are now rated separately, they are still part of the overall evaluation for his back disability, and so they are properly part of a request for an increased disability rating for that condition.  The separate neurological rating is simply a vehicle to provide "the maximum benefit allowed by law and regulation."  AB v. Brown, 6 Vet. App. 35, 38 (1993).  
Under 38 C.F.R. § 4.124a, the schedules for rating diseases of the cranial and peripheral nerves include alternate diagnostic codes for paralysis, neuritis, and neuralgia of each nerve.  See 38 C.F.R. § 4.124a, Diagnostic Codes 8205 to 8730.  The diagnostic codes for paralysis of a nerve allow for multiple levels of incomplete paralysis, as well as complete paralysis. However, the ratings available for neuritis and neuralgia of the same nerves can be limited to less than the maximum ratings available for paralysis.  In rating peripheral neuropathy attention is given to sensory or motor impairment as well as trophic changes (described at 38 C.F.R. § 4.104, DC 7115").  Peripheral neuropathy which is wholly sensory is mild or, at most, moderate.  With dull and intermittent pain in a typical nerve distribution, it is at most moderate.  With no organic changes it is moderate or, if of the sciatic nerve, moderately severe.  38 C.F.R. § 4.20.  Neuralgia of a peripheral nerve of a lower extremity can receive a maximum rating of moderate incomplete paralysis.  38 C.F.R. § 4.124.  Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, can receive a maximum rating of severe, incomplete paralysis.  38 C.F.R. § 4.123.  
'Sciatic' refers to the sciatic nerve; sciatica is used to refer to 'a syndrome characterized by pain radiating from the back into the buttock and into the lower extremity along its posterior or lateral aspect, and most commonly caused by prolapse of the intervertebral disk' the term is also used to refer to pain anywhere along the course of the sciatic nerve'."  Ferraro v. Derwinski, 1 Vet. App. 326, 329-30 (1991).  
Sciatic neurological manifestations are rated under Diagnostic Code 8520, 8620, or 8720 as, respectively, paralysis, neuritis or neuralgia of the sciatic nerve.  The criterion for a 10 percent rating is mild incomplete paralysis.  The criterion for a 20 percent is moderate incomplete paralysis and 40 percent when moderately severe.  When severe with marked muscular atrophy, 60 percent is warranted and 80 percent is warranted for complete paralysis (with foot drop, no active movement possible below the knee, and weakened or, very rarely, lost knee flexion).  See also 38 C.F.R. § 4.124a, Diagnostic Codes 8620, 8720 (for sciatic neuritis and neuralgia). 
As for rating the orthopedic manifestations, the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) is used and encompasses symptoms such as pain (radiating or not), stiffness, and aching but does not require that there be such symptoms for any particular rating.  68 Fed. Reg. at 51454 - 51455 (August 27, 2003). 
The General Rating Formula provides ratings based on limited spinal motion in either forward flexion or the combined ranges of motion of a spinal segment, or for either favorable or unfavorable ankylosis, or with respect to the entire spine a loss of more than 50 percent vertebral body height due to vertebral fracture or muscle spasm and guarding. 
Note 2 to the General Rating Formula sets forth normal ranges of motion of the spinal segments, which under Note 4 are measured to the nearest five (5) degrees, although a lesser degree of motion may be considered normal under the circumstances set forth in Note 3. 
Note 2 to the General Rating Formula provides that 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 sum of these is the combined range of motion, which for the thoracolumbar spine is 240 degrees.  Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  Note 5 of the General Rating Formula. 
A 10 percent rating is warranted for limited thoracolumbar motion when forward flexion is greater than 65 degrees but not greater than 85 degrees; or the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 234 degrees; or, there is muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent of more of the vertebral height.
A 20 percent rating is warranted for limited thoracolumbar motion when forward flexion is greater than 30 degrees but not greater than 60 degrees; or the combined range of motion is not greater than 120 degrees (the maximum combined range of motion being 240 degrees); or if there is either (1) muscle spasm or (2) guarding severe enough to result in abnormal gait or abnormal spinal contour, e.g., scoliosis, reversed lordosis, or abnormal kyphosis.  
A 40 percent rating is warranted for limited thoracolumbar motion when forward flexion is to 30 degrees or less; or, there is favorable ankylosis of the entire thoracolumbar spine.  A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine; and 100 percent for unfavorable ankylosis of the entire spine. 
Ratings for a joint based on limitation of motion require consideration of functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45.  In other words, ratings based on limited motion do not ipso facto include or subsume the other rating factors in §§ 4.40 and 4.45, e.g., pain, functional loss, fatigability, and weakness.  Thus, a higher rating may be assigned if there is additional limitation of motion from pain or limited motion on repeated use of the joint.  See DeLuca v. Brown, 8 Vet. App. 202 (1995).  Also with any form of arthritis, painful motion is factor to be considered.  Painful motion of a joint with periarticular pathology is to be at rated at least at the minimum compensable rating for the joint. 38 C.F.R. § 4.59.  See DeLuca v. Brown, 8 Vet. App. 202 (1995); Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); and Burton v. Shinseki, 25 Vet. App. 1, 5-6 (2011).  
The holding in Mitchell v. Shinseki, 25 Vet. App. 32, 40-41 (2011) that painful motion without functional loss did not constitute compensable limited motion, was premised on 38 C.F.R. §§ 4.40 and 4.45, but in Burton v. Shinseki, 25 Vet. App. 1, 5-6 (2011) it was held that painful motion without functional loss did warrant a minimum compensable evaluation under 38 C.F.R. § 4.59.  
Analysis
Initially, the Board will address potential entitlement to a higher rating based on incapacitating episodes of IVDS.  
In this regard, more than the Veteran's verbal assurance of incapacitating episodes of IVDS is required.  Rather, there must be not only treatment but bed rest prescribed by a physician.  Here, there is no evidence that the Veteran has ever been prescribed bed rest by a physician.  
Inasmuch as the Veteran had never been prescribed bed rest by a physician, he cannot have had "incapacitating episodes" within the meaning of the rating criteria in the Formula for Rating IVDS Based on Incapacitating episodes at 38 C.F.R. § 4.71a, Diagnostic Code 5243.  
It necessarily follows that the appropriate ratings may be assigned only for the orthopedic manifestations, for combination with any appropriate and separate rating for neurologic manifestations.
For a rating for the orthopedic manifestations of the lumbar DDD and IVDS in excess of 20 percent, the Veteran must have either (a) limitation of thoracolumbar flexion of 30 degrees or less; or, (b) favorable ankylosis of the entire thoracolumbar spine. 
In this regard, VA rating examinations have found that thoracolumbar flexion was to greater than 30 degrees.  Moreover, a review of the entire evidentiary record makes is indisputable that the Veteran does retain some thoracolumbar motion and, so, this precludes finding that he had any thoracolumbar ankylosis.  
With respect to the neurologic component, the 20 percent rating for sciatic radiculopathy of each lower extremity encompasses moderate impairment.  For the next higher rating, of 40 percent, there must be moderately severe impairment which, in turn, requires some degree of motor impairment or organic changes but, in this case, there is no clinical evidence of either motor impairment or organic changes due to sciatic radiculopathy.  
Accordingly, the Veteran does not meet the schedular criteria for an orthopedic rating in excess of 20 percent for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS.   
2.  Entitlement to a compensable rating for a right knee scar
Under 38 C.F.R. § 4.118 ratings are provided under DC 7800 for scars of the head, face or neck which are disfiguring.  DC 7801 provides for ratings for scar not of the head, face, or neck which are deep and nonlinear.  However, in this case as the Veteran’s scars do not affect his head, face or neck and, also, are neither deep nor nonlinear, DCs 7800 and 7801 are not applicable.  Similarly, DC 7802 provides for a 10 percent rating for scar which are superficial and nonlinear if the affected area or areas are of 144 square inches (929 sq.cms.) or greater, but because here the total surface are of the affected fingers is not 144 square inches or greater DC 7802 is not applicable.  
Under DC 7804, as to scars which are unstable or painful, one or two scars warrant a 10 percent rating.  Three of four scars warrant a 20 percent rating.  Five or more scars warrant 30 percent rating.  
Notes to the criteria for rating scars provide that a superficial scar is one not associated with underlying soft tissue damage.  An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  
Note 2 to DC 7804 provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars.  
DC 7805 provides that any disabling effects of scars not considered in a rating under DCs 7800 – 7804 are to be rated under an appropriate diagnostic code.
In this case, the evidence shows that the Veteran’s right knee scar is superficial but it is not unstable and is neither tender nor painful.  Accordingly, a compensable evaluation for the right knee scar is not warranted.  
3.  Entitlement to an effective date prior to September 29, 2011, for service connection for radiculopathy of the right lower extremity
4.  Entitlement to an effective date prior to September 29, 2011, for service connection for radiculopathy of the left lower extremity
5.  Entitlement to an effective date prior to September 29, 2011, for service connection for a scar of the right knee
Service Connection Effective Dates
A rating decision is final unless an appeal is initiated within one year from the date of notification thereof.  38 U.S.C. § 7105(c) (West 2014); 38 C.F.R. §§ 3.104(a), 20.200, 20.302(a) and (b), 20.1103 (2017).   
The effective date for an award of service connection based on an original claim generally "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor."  38 U.S.C. § 5110(a) (emphasis added); 38 C.F.R. § 3.400(b)(2)(i) (stating that the effective date for disability compensation is the "date of receipt of claim, or date entitlement arose, whichever is later").  As the Court has explained, "[t]he effective date of an award of service connection is not based on the date of the earliest medical evidence demonstrating 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).  One exception to this general rule is where an application for disability compensation is received within one year from separation from active service; in this situation, the effective date of an award "shall be" the day following separation from active service.  38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i).
As to any argument for an earlier effective date for service connection retroactive to the day after service discharge, when the initial claim was not received until years thereafter, under the governing statutory and regulatory provisions, 38 U.S.C. §§ 5101, 5110; 38 C.F.R. § 3.400, the claim-filing date is the earliest permissible effective date for benefits.  38 U.S.C. § 5101(a) requires the filing of a claim before a veteran will receive benefits, and 38 U.S.C. § 5110(a) provides that “[u]nless specifically provided otherwise in this chapter, the effective date of an award based on an original claim ... of compensation ... shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.”  Id. § 5110(a) (emphasis added).  The relevant implementing regulation states that unless the VA receives a claim within one year after a veteran’s separation from service, the effective date for that veteran’s receiving disability compensation is the “date of receipt of claim, or date entitlement arose, whichever is later.”  38 C.F.R. § 3.400(b).  (emphasis added).  
The Board now explains that effective date earlier than September 29, 2011, for the award of service connection for radiculopathy of each lower extremity and for scarring of the right knee is barred because the Veteran's application, was not received by the RO until September 29, 2011.  
A thorough review of the entire record reveals that there is no correspondence between VA and the Veteran prior to September 29, 2011, i.e., the current effective date of service connection, which can reasonably be construed as a formal or informal claim for compensation because the correspondence makes no reference to radiculopathy of the lower extremities or right knee scarring.  Moreover, medical treatment records prior to the current effective date of September 29, 2011, do not constitute a claim for benefits.  See Caluza, 7 Vet. App. at 506; Gilbert, 1 Vet. App. at 52; see also Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009) (stating that "the essential requirements of 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"); Brannon v. West, 12 Vet. App. 32, 35 (1998) (holding that the "mere presence" of medical evidence is insufficient to establish the intent necessary for an informal claim for VA benefits).
Indeed, the Board notes that on VA examinations in December 1999 and as late as March 3, 2011, the Veteran had no complaints of radiculopathy and there were no clinical findings of radiculopathy.  
Also, the effective date of September 29, 2011, for the grants of service connection for radiculopathy of each lower extremity was set by the June 23, 2013, rating decision.  That decision is final because the Veteran did not perfect an appeal and, it must be noted, there is no allegation of clear and unmistakable error (CUE) in that decision.  The Veteran may not now seek to avoid the finality of the June 23, 2013, rating decision simply by claiming entitlement to an earlier effective date; rather, his remedy had been to appeal the June 23, 2013 rating decision but, as noted, he initiated an appeal only as to the initial ratings assigned and not to the assignment of September 29, 2011, as the proper effective dates for those grants of service connection.  
Accordingly, an effective date prior to September 29, 2011, for grants of service connection for radiculopathy of the left lower extremity, radiculopathy of the right lower extremity, and a scar of the right knee is not warranted.  

Effective Date for Disability Ratings
The effective date of an award for an increased rating shall be the date of receipt of the formal or informal claim, or the earliest date as of which it is factually ascertainable that an increase in disability had occurred, whichever is later.38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(1).  Stated conversely, the effective date of an increased rating is the date of ascertainable increase or date of receipt of formal or informal claim, whichever is later under 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400(o)(1).  If, however, the ascertainable increase precedes receipt of the formal or informal claim, then the effective date is the date of ascertainable increase, if the claim is received within one year thereof under 38 U.S.C. § 5110(b)(2) and 38 C.F.R. § 3.400(o)(2).  See also 38 C.F.R. § 3.157(a) and Harper v. Brown, 10 Vet. App. 125, 126 (1997).  
As noted in Harper v. Brown, 10 Vet. App. 125, 126 (1997), 38 U.S.C. § 5110(b)(2) and 38 C.F.R. § 3.400(o)(2) are applicable only where the increase precedes the claim and not when a claim is filed and the increase in disability is subsequently ascertainable (as in Harper when the claim was filed first and increase was ascertained during subsequent VA hospitalization or by a VA examination after the claim is filed).  
Thus, the proper analysis is determining the earliest date that an increased rating was ‘ascertainable’ within the meaning of 38 U.S.C. § 5110(b)(2) and if ascertainable on a date within one year before receipt of the claim for such increase, the effective date should be the date of ascertainable increase; otherwise, the proper effective date is the date of receipt of the formal or informal claim.  Hazan v. Gober, 10 Vet. App. 511, 521 (1997).  

Effective Date Prior to September 29, 2011 for Ratings for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS and PO residuals of surgery of each knee with PFS
The dispositive matter in this case is that a June 25, 2013, rating decision granted an increase to 20 percent for each of these disabilities (the low back, and PO surgical residuals of each knee with PFS) as of September 29, 2011.  As described earlier, the Veteran initiated an appeal of that decision but after the issuance of an SOC the appeal was never perfected by the filing of a Substantive Appeal, VA Form 9 or equivalent.  
Accordingly, the June 25, 2013, rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104(a), 20.200, 20.302, 20.1103 (2017).  There has been no allegation of clear and unmistakable error (CUE) in the June 25, 2013, rating decision which would potentially allow for a determination that the rating decision was invalid and, so, not final.  However, absent CUE, the Veteran may not now circumvent the finality of the June 25, 2013, rating decision be simply claiming entitlement to an earlier effective date for the 20 percent rating.  
6.  Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS
The current effective date of September 29, 2011, for the 20 percent rating for lumbar spine DJD with L5 spondylolysis, spondylolisthesis, and IVDS has been set as of the date of receipt of the claim for an increased rating.  Prior thereto there was no unadjudicated claim for an increased rating for that disability.  Moreover, for a 20 percent rating there would have to have been limited thoracolumbar flexion to less than 60 degrees, or a combined range of motion of not more than 120 degrees, or an abnormality of gait or spinal contour caused by muscle spasm or guarding.  
A 20 percent rating is warranted for limited thoracolumbar motion when forward flexion is greater than 30 degrees but not greater than 60 degrees; or the combined range of motion is not greater than 120 degrees (the maximum combined range of motion being 240 degrees); or if there is either (1) muscle spasm or (2) guarding severe enough to result in abnormal gait or abnormal spinal contour, e.g., scoliosis, reversed lordosis, or abnormal kyphosis.  In this regard, on VA examination in December 1999 his gait was normal, thoracolumbar flexion was to 95 degrees.  Moreover, his combined range of motion was 280 degrees, more than twice that required for a 20 percent disability rating.  
Thus, there was no unadjudicated claim prior to September 29, 2011, for an increased rating and, also, prior to that time it was not factually ascertainable that a rating of 20 percent for the service-connected low back disorder was warranted.  
7.  Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of right knee surgery with PFS
Knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint.  While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant DCs for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration.  Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, and lateral instability and recurrent subluxation of the knee.  The Board will explore all possibilities in this case.
DC 5260 rates based on limitation of flexion.  When flexion of the leg is limited to 60 degrees, a noncompensable rating is warranted.  When flexion is limited to 45 degrees, a 10 percent rating is warranted.  Flexion limited to 30 degrees warrants a 20 percent rating, while flexion limited to 15 degrees warrants the maximum 30 percent rating.  
DC 5261 rates based on limitation of extension.  That code provides that when extension is limited to 5 degrees, a noncompensable rating is assigned.  Extension limited to 10 degrees warrants a 10 percent rating.  When limitation of extension is at 15 degrees, a 20 percent rating is warranted.  Extension limited to 20 degrees warrants a 30 percent rating.  Extension limited to 30 degrees warrants a 40 percent rating.  Lastly, extension limited to 45 degrees warrants the maximum, 50 percent rating.
DC 5010 directs that arthritis due to trauma be rated as degenerative arthritis under 38 C.F.R. § 4.71a, DC 5003.  Under that code, the Schedule directs that degenerative arthritis that has been established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joints involved (for example, DC 5260 and 5261 above).  It further states that when the limitation of motion is noncompensable under the code, a rating of 10 percent is for application for each such major joint affected by limitation of motion.  38 C.F.R. § 4.71a, DC 5003.  If there is accompanying incapacitating episodes, a 20 percent is for application.
As a final note, additional knee codes exist.  However, the Veteran does not have ankylosis of either knee, does not have impairment of the tibia and fibula due to malunion or nonunion, and does not have acquired genu recurvatum.  Thus, DCs 5256, 5262, 5263, respectively, are not for consideration.  
The current effective date of September 29, 2011, for the 20 percent rating for PO residuals of right knee surgery with PFS has been set as of the date of receipt of the claim for an increased rating.  Prior thereto there was no unadjudicated claim for an increased rating for that disability.  
The current rating has been assigned under 38 C.F.R. § 4.71a, DC 5258 which provides that dislocated semilunar cartilage, with frequent episodes of locking, pain, and effusion into the joint warrants a 20 percent rating.  Prior to September 29, 2011, a 10 percent rating was assigned under DC 5224, as tenosynovitis.  

Accordingly, an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of right knee surgery with PFS is not warranted.
8.  Entitlement to an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of left knee surgery with PFS
The current effective date of September 29, 2011, for the 20 percent rating for PO residuals of left knee surgery with PFS has been set as of the date of receipt of the claim for an increased rating.  Prior thereto there was no unadjudicated claim for an increased rating for that disability.  
Accordingly, an effective date prior to September 29, 2011, for a 20 percent rating for PO residuals of left knee surgery with PFS is not warranted. 
9.  Entitlement to a combined rating in excess of 80 percent prior to September 29, 2011
38 U.S.C. § 1157 (West 1991) provides that:
The Secretary shall provide for the combination of ratings and pay compensation at the rates prescribed in subchapter II of this chapter to those veterans who served during a period of war and during any other time, who have suffered disability in line of duty in each period of service.  
Pursuant to that statute, VA’s Combined Ratings Table is found a 38 C.F.R. § 4.25.  It provides that the distinct disability ratings applied for each service-connected disability are not added but are combined using the procedure set forth in 38 C.F.R. § 4.25, with consideration given to what is called the “Bilateral Factor” at 38 C.F.R. § 4.26.  
In this case, the Veteran’s service-connected disabilities combined, even with consideration of the bilateral factor to no more than 80 percent only as of September 29, 2011.  
The Board observes that the calculation of a combined rating under 38 C.F.R. §§ 4.25 and 4.26 is purely a matter of mathematical computation and leaves no room for discretion by VA adjudicators.  In other words, once disability ratings are calculated for each service-connected disorder, the determination of the overall combined disability rating is arrived at by operation of law.  
Additionally, the Board observes that a December 1, 2016, rating decision granted service connection for hearing loss which was assigned an initial 20 percent disability rating and granted service connection for tinnitus, which was assigned an initial 10 percent rating, all effective April 16, 2016.  This rating decision made no change in the combined disability rating of 100 percent which had been made effective December 18, 2015.  
In VA Form 21-4138, Statement in Support of Claim, dated March 13, 2017, the Veteran stated that in light of the recent grants of 20 percent for hearing loss and 10 percent for tinnitus, he did not understand why his monthly compensation had not increased and if he was authorized for more each month he requested that his monthly compensation be changed to reflect this with retroactive pay.  
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By RO letter of June 27, 2017, it was explained to the Veteran that as to his March 13, 2017, request to verify his monthly compensation a review of his file revealed that his overall or combined evaluation was 100% effective December 18, 2015.  However, VA did not add the individual percentages of each condition to determine his combined rating.  Instead, VA used a combined rating table that considered the effect from the most serious to the least serious conditions.  He was currently being paid at the maximum rate allowable by law.  
In sum, a combined rating in excess of 80 percent prior to September 29, 2011, is not allowed by law.
 
DEBORAH W. SINGLETON
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Department of Veterans Affairs