Citation Nr: 18145485 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 12-33 764A DATE: October 29, 2018 ORDER Service connection for a right thumb disability is denied. An initial rating in excess of 10 percent for service-connected Bell’s palsy affecting the right side of the face is denied. An initial rating in excess of 40 percent for service-connected temporomandibular joint dysfunction (TMJ) affecting the right side of the face is denied. Prior to March 30, 2018, a rating in excess of 10 percent for service-connected hepatitis B is denied. Since March 30, 2018, a rating in excess of 20 percent for service-connected hepatitis B is denied. An effective date earlier than January 13, 2014 for the grant of increased evaluation of 10 percent for service-connected hepatitis B is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for service-connected a trigeminal cranial nerve neuropathy affecting the right side of the face is remanded. Entitlement to an effective date earlier than December 18, 2012 for the grant of service connection for trigeminal cranial nerve neuropathy affecting the right side of the face is remanded. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of a right thumb disability; he did not have a clinically diagnosed right thumb disability when he filed his claim or any time during the pendency of the claim. 2. Throughout the appeal period, the Veteran’s service-connected Bell’s palsy affecting the right side of the face has resulted in “moderate” but not “severe” incomplete paralysis of cranial nerve VII. 3. The Veteran’s TMJ affecting the right side of the face is currently assigned the maximum 40 percent schedular evaluation for limitation of inter-incisal motion between 0 and 10 mm. 4. Prior to March 30, 2018, the Veteran’s hepatitis B was manifested by intermittent right upper quadrant pain and intermittent weakness; it did not result in daily fatigue, malaise, or anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication; or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, and arthralgia) having a total duration of at least two weeks, but less than four weeks, during the past twelve-month period. 5. Since March 30, 2018, the Veteran’s hepatitis B has been manifested by daily fatigue and right upper quadrant pain; it has not resulted in malaise and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes (with symptoms such as malaise, nausea, vomiting, anorexia, and arthralgia) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. 6. The Veteran’s increased rating claim for hepatitis B was received on January 13, 2014; and no medical evidence within a year prior to this date showed that an increased rating for hepatitis B was warranted. CONCLUSIONS OF LAW 1. The criteria for service connection for a right thumb disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for an initial rating in excess of 10 percent for service-connected Bell’s palsy affecting the right side of the face have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, Diagnostic Code 8207. 3. The criteria for an evaluation in excess of 40 percent for service-connected TMJ affecting the right side of the face are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 3.951, 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.150, Diagnostic Codes 9900-9916. 4. Prior to March 30, 2018, the criteria for a rating in excess of 10 percent for service-connected hepatitis B have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7345. 5. Since March 30, 2018, the criteria for a rating in excess of 20 percent for service-connected hepatitis B have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7345. 6. The criteria for an effective date prior to January 13, 2014, for the grant of an increased rating of 10 percent for service-connected hepatitis B have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This is a highly complex case. In this regard, the Veteran needs to be aware that the Board has undergone an extensive review of the record: The Veteran served on active duty in the United States Navy from June 2000 to November 2009. These matters come before the Board of Veterans’ Appeals (Board) on appeal from July 2010, December 2013, July 2014, and April 2018 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Manila, Commonwealth of the Philippines. In a July 2010 rating decision, the Board granted entitlement to service connection for Bell’s palsy affecting the right side of the face and for temporomandibular joint dysfunction (TMJ). The Veteran’s Bell’s palsy was rated 10 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8207, and his TMJ was rated 40 percent disabling under 38 C.F.R. § 4.150, Diagnostic Code 9905. These initial disability ratings were made effective November 17, 2009. In May 2011, the Veteran filed a notice of disagreement contesting these initial ratings. In July 2013, he filed a substantive appeal to the Board to determine whether he was entitled to an initial rating in excess of 10 percent for Bell’s palsy affecting the right side of the face and to an initial rating in excess of 40 percent for TMJ affecting the right side of the face. In a December 2012 supplemental claim for compensation, the Veteran filed a claim seeking entitlement to service connection for residuals of orthognathic surgery manifested by numbness of the chin, pain and swelling in the lip, and a tingling sensation in the gum area. In July 2013, the Veteran submitted a statement clarifying that his claim for residuals of orthognathic surgery manifested by numbness of the chin, pain and swelling in the lip, and a tingling sensation in the gum area, should not be considered part of his appeal for increased initial evaluations of Bell’s palsy or TMJ. In an October 2013 medical opinion, a VA examiner opined that the Veteran’s Bell’s palsy was incurred during his first year of military service. The examiner noted that the Veteran’s Bell’s palsy affected the seventh cranial nerve on the right side of his face. In contrast, the examiner noted that the Veteran’s trigeminal nerve neuropathy developed as a residual of nerve damage sustained during orthognathic surgery performed during service in 2007 and 2008. The examiner noted that the Veteran’s trigeminal nerve neuropathy affected the fifth cranial nerve on the right side of his face and was separate and distinct from the Veteran’s Bell’s palsy and TMJ affecting the right side of his face. In light of the above, in its December 2013 rating decision, the RO granted entitlement to service connection for trigeminal nerve neuropathy affecting the right side of the face. Under 38 C.F.R. § 4.124a, Diagnostic Code 8205, an initial 10 percent disability rating was assigned, effective December 18, 2012. In December 2013, the Veteran filed a notice of disagreement contesting the initial rating. In April 2014, he filed a substantive appeal to the Board to determine whether he was entitled to an initial rating in excess of 10 percent for trigeminal nerve neuropathy affecting the right side of his face. The Board finds that the Bell’s palsy claim is ready for appellate review. The merits of that claim will be discussed in the decision below. In contrast, the trigeminal nerve neuropathy claim requires additional development. That development will be addressed in the Remand section below. The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Service Connection Claim Service connection may be granted for disability resulting from disease or injury incurred in, or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a current disability; (2) the in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for Veterans Claims (Court) has held that Congress specifically limited entitlement to service connected benefits to cases where there is a current disability. “In the absence of proof of a present disability, there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. In addressing lay evidence and determining its probative value, if any, attention is directed to both competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent regarding a disease with “unique and readily identifiable features” that is “capable of lay observation.” Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 1. Entitlement to service connection for a right thumb disability. The Veteran is seeking entitlement to service connection for a right thumb disability which he attributes to an injury he sustained during military service in November 2003. Specifically, the Veteran asserts that he smashed his right thumb between a cruise box and a ladder. He claims that he immediately experienced swelling and pain and was treated with a splint being placed on his thumb and some pain medication. The Veteran further contends that he regained normal range of motion in his thumb after he separated from service but noted that flexion of his thumb becomes limited because of flare-ups of pain during cold weather and prolonged use when writing. He likewise claims to have a weaker grip when using his right hand. As an initial matter, the Board notes that a July 2010 rating decision granted entitlement to service connection for carpal tunnel syndrome (CTS) of the right hand on the basis that a June 2010 VA examination showed a diagnosis of that chronic condition within one year of his discharge from military service. A 10 percent disability rating was assigned, effective May 26, 2010. In July 2013, the Veteran filed a claim for a “right hand condition resulting from a cruise box slamming on my hand on November 28, 2003.” Given the prior grant of service connection for CTS of the right hand, the RO interpreted this statement as a distinct claim for “right thumb joint arthralgia” that was separate from his prior claim seeking compensation for right hand carpal tunnel syndrome. See December 2013 rating decision. Accordingly, the issue before the Board is narrowly construed as entitlement to service connection for a right thumb disability. The question for the Board is whether the Veteran has a current right thumb disability that began during service or is “at least as likely as not” related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current right thumb disability. In fact, the Veteran did not have a right thumb disability when he filed his claim, and he has not been diagnosed as having a right thumb disability at any time during the pendency of the claim. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain, 21 Vet. App. at 321. The Veteran’s service treatment records (STRs) confirm that he sustained an injury to his right thumb when he smashed it between a cruise box and ladder while on active duty in November 2003 (this is not in dispute). At the time, the Veteran presented for treatment with pain and swelling in his right thumb and general weakness in his right hand. No paresthesias or numbness was reported. It was noted that flexion was limited to 105 degrees due to pain. The Veteran’s thumb was placed in a splint and he was given pain medication. A follow-up appointment twelve days later revealed complaints of mild pain and continued swelling of the right first metacarpal phalangeal joint (i.e., the thumb joint). Mild tenderness to palpation and good passive range of motion was noted. The examiner noted that the Veteran was limited due to swelling and pain. X-ray did not reveal any right thumb fracture. Despite the STRs demonstrating that the Veteran injured his thumb while on active duty, the post-service medical records do not contain any documentation of diagnosis or treatment for a chronic right thumb disability. Moreover, the Veteran was afforded a VA thumb examination in November 2013. Based on a review of the claims file, to include the STRs and post-service VA treatment records, as well as a physical evaluation of the Veteran, the VA examiner opined that the Veteran had right thumb joint arthralgia (i.e., joint pain) in 2003 but did not have a current right thumb disability. Based on the subjective complaints of the Veteran, the VA examiner indicated that the Veteran had pain on movement and less movement than normal in his right thumb. The examiner found that the Veteran had normal flexion and extension and that his thumb pain would generally flare-up during prolonged use of the thumb (such as writing) and result in moderate impact to the Veteran’s right hand. The examiner opined that pain during flare-ups was the cause of the limitation in range of motion (thumb flexion) resulting to more than two inches gap when opposing thumb with other fingers. Nevertheless, diagnostic testing did not reveal any abnormal findings – there were no evident osseous changes and joint spaces were intact. The examiner essentially concluded that the Veteran did not have a current right thumb disability. To the extent that the Veteran experiences right thumb joint pain, the Board notes that until recently, pain alone, without a diagnosis or identifiable underlying malady or condition, did not in and of itself constitute a disability for which service connection could be granted. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001). However, in Saunders v. Wilkie, No. 2017-1466, 2018 U.S. App. LEXIS 8467 (Fed. Cir. Apr. 3, 2018), the United States Court of Appeals for the Federal Circuit (Federal Circuit) found that the term “disability” as used in 38 U.S.C. 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a “disability.” The Federal Circuit also limited its holding, stating, “We do not hold that a veteran could demonstrate service connection simply by asserting subjective pain . . . to establish the presence of a disability, the veteran will need to show that [his or her] pain reaches the level of functional impairment of earning capacity.” Accordingly, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. The Board has considered whether the Veteran’s claimed right thumb pain is of such severity that it would be considered a “disability” as used in 38 U.S.C. 1110. While functional loss caused by pain is akin to functional loss caused by physical disability, in this case, the Veteran has not demonstrated evidence of a right thumb disability. Cf. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Other than during flare-ups, the Veteran was found on examination to exhibit normal flexion and extension of the thumb. On initial range of motion testing, the examiner found that the Veteran had pain on movement and less movement than normal but no limitation in range of motion (flexion or extension) involving the right thumb and no additional loss in range of motion (flexion or extension) during repetitive use testing of the right thumb. While pain on palpation was found on evaluation, the examiner found normal muscle strength, no ankylosis, and no other pertinent physical findings, complications, conditions, signs, or symptoms involving the Veteran’s right thumb. Simply stated, the best evidence in this case provides evidence against the existence of a current right thumb “disability” at this time. The Board has also carefully considered the Veteran’s lay statements regarding the onset and manifestations of his claimed right thumb disability. However, regardless of what the Veteran claims he experienced during his military service, the fact remains that the Veteran does not have a currently diagnosed right thumb disability. While the Veteran may believe that he has a current diagnosis of a right thumb disability that began during service, he is not competent to provide such a diagnosis in this case. Establishing a diagnosis of a right thumb disability is medically complex, as it requires specialized medical education, knowledge of upper extremity/hand joints, and the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377, 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence than to the Veteran’s lay statements and finds that the preponderance of the evidence is against the Veteran’s claim. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 55. Service connection for a right thumb disability is denied. Increased Rating Claims Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability demonstrates symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), reversed in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant. Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an initial rating in excess of 10 percent for service-connected Bell’s palsy (facial cranial nerve neuritis) affecting the right side of the face. The Veteran is seeking entitlement to a higher initial rating for service-connected Bell’s palsy affecting the right side of his face. His Bell’s palsy has been rated 10 percent disabling under the criteria for paralysis of the seventh (facial) cranial nerve. Bell’s palsy, also known as facial nerve neuritis, generally causes some degree of paralysis of the seventh cranial nerve in the face. Therefore, evaluation of this disability under 38 C.F.R. § 4.124a, Diagnostic Code 8207, is appropriate. Pursuant to the Diagnostic Code 8207, a 10 percent rating is assigned for “moderate” incomplete paralysis of cranial nerve VII. A 20 percent rating is assigned for “severe” incomplete paralysis of cranial nerve VII. Finally, a 30 percent rating is assigned for complete paralysis of cranial nerve VII. 38 C.F.R. § 4.124a, Diagnostic Code 8207. These ratings are dependent on relative degree of sensory manifestation or motor loss. Moreover, the ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor. 38 C.F.R. § 4.124a. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124. Additionally, the Board observes that the terms “moderate” and “severe” are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Essentially, the determination between “moderate” and “severe” incomplete paralysis is a factual finding, and must be based on consideration of all the reported symptoms, not just the final subjective conclusion of an examiner. Here, there is insufficient evidence for initial ratings in excess of 10 percent for either Bell’s palsy or trigeminal nerve neuropathy, as the Veteran’s symptoms do not appear to be more than moderate in nature. Muscle strength and sensory testing during his VA examinations revealed, at worst, that the Veteran’s trigeminal nerve neuropathy resulted in moderate incomplete paralysis of the seventh cranial nerve. See April 2012, June 2013, and December 2017 VA cranial nerve examination reports. These examinations did not find that the Veteran’s neurological symptoms were ever productive of “severe” incomplete paralysis of the seventh cranial nerve. Id. In considering the appropriate disability rating, the Board has also considered the Veteran’s statements that his Bell’s palsy is worse than the rating he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his Bell’s palsy according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (finding that “although interest may affect the credibility of testimony, it does not affect competency to testify”). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s Bell’s palsy has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. Moreover, the Board has considered other diagnostic codes used to evaluate diseases of the cranial nerves and finds that these diagnostic codes are inapplicable in this case based on the Veteran’s symptomatology throughout the appeal period. In sum, the Board find’s that the Veteran’s Bell’s palsy affecting the right side of his face has been manifested, at most, by “moderate” incomplete paralysis of the seventh cranial nerve; that paralysis has never been found to be “severe” or complete. As such, a 10 percent rating is the maximum rating available under the diagnostic code to compensate for the severity of the Veteran’s Bell’s palsy symptomatology and disability picture throughout the appeal period. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Regarding this claim on appeal, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). 3. Entitlement to an initial rating in excess of 40 percent for service-connected temporomandibular joint dysfunction (TMJ) affecting the right side of the face. The Veteran’s service-connected TMJ is currently rated 40 percent disabling under Code 9905, for limitation of motion of the temporomandibular joint, effective November 17, 2009. Under 38 C.F.R. § 4.150, Diagnostic Code 9905, limited motion of the temporomandibular articulation can be rated as either inter-incisal impairment (opening and closing) or lateral excursion impairments (side to side). The criteria specifically state that both cannot be rated simultaneously. 38 C.F.R. § 4.150, Diagnostic Code 9905, Note. Lateral excursion limited to 0 to 4 mm is rated 10 percent disabling; this is the sole rating assignable for this manifestation. Limitations of inter-incisal motion are rated up to a maximum of the currently assigned initial 40 percent evaluation for a range of motion of between 0 and 10 mm. 38 C.F.R. § 4.150, Diagnostic Code 9905. Thus, despite any evidence, no higher evaluation is permitted under this code. The Board has considered other potentially applicable diagnostic codes. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). But here, the evidence of record does not show loss of any portion of the mandible or maxilla, malunion or nonunion of the mandible or maxilla, loss of teeth, loss of coronoid/condyloid process, osteomyelitis, or loss of ramus. See April 2012, June 2013, March 2014, and December 2017 VA TMJ examination reports. Accordingly, no higher evaluation is warranted under other potentially applicable diagnostic codes. See 38 C.F.R. § 4.150, Diagnostic Codes 9900, 9901, 9902, 9903, 9904, 9906, 9907-9916; In sum, the Board concludes that the Veteran did not meet the criteria for increased ratings during the period on appeal for his service-connected TMJ. As the preponderance of the evidence is against the assignment of any higher rating, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As a final matter, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). 4. Entitlement to a rating in excess of 10 percent for service-connected hepatitis B, prior to March 30, 2018, and to a rating in excess of 20 percent thereafter. In its July 2010 rating decision, the RO granted service connection for the Veteran’s hepatitis B and assigned a noncompensable (0 percent) disability rating, effective November 17, 2009. In January 2014, the Veteran filed a claim seeking an increased rating for his service-connected hepatitis B. Later that same month, he was afforded a VA hepatitis examination. In its July 2014 rating decision, the RO increased the previously assigned disability rating from noncompensable (0 percent) to 10 percent, effective January 13, 2014. The Veteran appealed that rating. He was afforded a new VA hepatitis examination on March 30, 2018. In an April 2018 rating decision, the RO again increased the assigned disability rating from 10 to 20 percent, effective March 30, 2018, the first date in the record it was factually ascertainable that an increase in disability occurred. As the Veteran has not received a total grant of benefits sought on appeal for his service-connected hepatitis B, this issue remains on appeal before the Board. AB v. Brown, 6 Vet. App. 35 (1993). The Veteran’s hepatitis B residuals have been rated 10 percent disabling prior to March 30, 2018, and then 20 percent disabling since that date. Under 38 C.F.R. § 4.114, Diagnostic Code 7345, which provides the criteria for evaluating chronic liver disease without cirrhosis, a 10 percent rating is assigned for hepatitis with intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week but less than two weeks in the prior 12-month period. A 20 percent evaluation is assigned for daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks but less than four weeks during the past 12-month period. A 40 percent evaluation is assigned for daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. A 60 percent evaluation is assigned for daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition) and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. Finally, a 100 percent evaluation is warranted for hepatitis with serologic evidence of infection and near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). Note (1) explains that “incapacitating episodes” means a period of acute symptoms severe enough to required bed rest and treatment by a physician. 38 C.F.R. § 4.114. After reviewing the evidence of record, the Board finds that the Veteran’s hepatitis B does not warrant a rating in excess of 10 percent prior to March 30, 2018, or a rating in excess of 20 percent after that date. See 38 C.F.R. § 4.114, Diagnostic Code 7345. Prior to March 30, 2018, the Veteran’s hepatitis B was found to be productive of intermittent right upper quadrant pain and intermittent weakness. It did not result in daily fatigue, malaise, or anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication; or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, and arthralgia) having a total duration of at least two weeks, but less than four weeks, during the past twelve-month period. See January 2014 VA hepatitis examination report. Based on the foregoing evidence, the Board finds that the Veteran’s hepatitis symptoms did not meet the criteria for a 20 percent or higher disability rating prior to March 30, 2018. See 38 C.F.R. § 4. 114, Diagnostic Code 7345, criteria for 20 percent rating. Since March 30, 2018, the Veteran’s hepatitis B has been productive of daily fatigue and right upper quadrant pain. It has not resulted in malaise and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes (with symptoms such as malaise, nausea, vomiting, anorexia, and arthralgia) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. See March 2018 VA hepatitis examination report. Based on the foregoing evidence, the Board finds that the Veteran’s hepatitis symptoms have not met the criteria for a 40 percent or higher disability rating since March 30, 2018. See 38 C.F.R. § 4. 114, Diagnostic Code 7345, criteria for 40 percent rating. The Veteran’s service-connected hepatitis is listed in VA’s schedule for rating disabilities. As such, consideration of other diagnostic codes is not necessary. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) (“[W]hen a condition is specifically listed in the Schedule, it may not be rated by analogy.”) Within the two staged periods, hepatitis B symptoms were generally consistent such that additional staged ratings are not appropriate. See Hart, 21 Vet. App. at 509-10. Regarding this issue, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). Effective Date Claim Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application thereof. 38 U.S.C. 5110; 38 C.F.R. § 3.400. 5. Entitlement to an effective date earlier than January 13, 2014 for the grant of an increased rating of 10 percent for service-connected hepatitis B. The Veteran contends that he should have an effective date earlier than January 13, 2014, for the grant of an increased rating of 10 percent for his service-connected hepatitis B. The RO granted service connection for hepatitis B in a July 2010 rating decision. The Veteran submitted his increased rating claim for hepatitis B that was received by the RO on January 13, 2014. The Board is aware that this case predates the changes to 38 C.F.R. § 3.155, and therefore the older version of the regulation applies. See 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014) (amendments are applicable with respect to claims and appeals filed on or after March 24, 2015). Nonetheless, the evidence did not demonstrate that entitlement to an increased rating was warranted within one year prior to the claim. His increased rating of 10 percent was granted based on the findings of a VA examination that occurred on January 27, 2014. There also was no correspondence received from the Veteran prior to January 13, 2014 indicating his desire to file an increased rating claim for his service-connected hepatitis B. The Veteran does not contend otherwise. There is no reasonable doubt to be resolved in this matter. The Veteran’s claim is denied. Other Considerations The Veteran has not asserted that his service-connected disabilities on appeal prevent him from obtaining and maintaining substantially gainful employment, and nothing in the record before the Board indicates such a problem. In fact, the evidence of record shows that the Veteran is currently working. Accordingly, the Board finds that the issue of entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities has not been raised by the record. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for service-connected trigeminal cranial nerve neuropathy affecting the right side of the face. 2. Entitlement to an effective date earlier than December 18, 2012 for the grant of service connection for trigeminal cranial nerve neuropathy affecting the right side of the face. In January 2014, the Veteran requested a hearing with a Decision Review Officer (DRO). He indicated that he wished to discuss the nerve damage affecting his jaw, lips, and chin that had originally been considered as part of his Bell’s palsy claim but had recently been granted a separate 10 percent rating. At the May 2017 hearing, the DRO noted that the Veteran would be presenting testimony regarding the issue of entitlement to an increased evaluation greater than 10 percent for his service-connected Bell’s palsy, right side of the face. The DRO did not mention the Veteran’s separate trigeminal cranial nerve neuropathy claim. Regarding his trigeminal nerve neuropathy, the Veteran stated, “[W]hen they did the procedure . . . they exposed the nerve in my mouth . . . they damaged it . . . [and] there are many times the right side of my face would be numb.” When asked by the DRO whether his Bell’s palsy had worsened, the Veteran responded in the affirmative. Although the DRO specifically referred to the Veteran’s Bell’s palsy, it is clear from his testimony that he believed that both his Bell’s palsy and trigeminal nerve neuropathy had recently worsened in severity. Based on the Veteran’s response, the RO scheduled the Veteran for a VA cranial nerve examination “for the established compensation condition of Bell’s palsy.” The Veteran presented for the examination in December 2017. While the VA examiner provided an adequate evaluation of the Veteran’s Bell’s palsy affecting his seventh cranial nerve on the right side of his face, the examiner did not discuss the Veteran’s service-connected trigeminal nerve neuropathy affecting his fifth cranial nerve on the right side of his face. Significantly, the examiner did not report any symptoms associated with a cranial nerve neuropathy affecting cranial nerve V. Furthermore, the examiner reported that the Veteran’s cranial nerve V had normal muscle strength and sensation. In the section of the examination report addressing paralysis, the examiner indicated that cranial nerve V on the right side of the face was not affected by any degree of paralysis. The evaluation of this type of disability is particularly complex. While these findings do not necessarily contradict the reports made by the other VA examiners of record, it remains unclear whether the examiner only evaluated the Veteran’s Bell’s Palsy and not his trigeminal nerve neuropathy or whether the examiner found that the trigeminal nerve neuropathy was not as severe or symptomatic as previously indicated. A new examination is necessary to properly assess the severity of the Veteran’s trigeminal nerve neuropathy and the impact it has on the fifth cranial nerve on the right side of his face. The earlier effective date claim listed above is inexplicably intertwined with the Veteran’s claim seeking an increased initial rating for his service-connected trigeminal cranial nerve neuropathy affecting the right side of the face, which is being remanded for further development. Therefore, a final decision on the issue of entitlement to an effective date earlier than December 18, 2012 for the grant of service connection for a trigeminal cranial nerve neuropathy affecting the right side of the face cannot be rendered at this time. See Harris v. Derwinski, 1 Vet. App. 180 (1991). These matters are REMANDED for the following actions: 1. Contact the Veteran and ask him to identify whether there are any outstanding VA or private medical records reflecting treatment for his trigeminal cranial nerve neuropathy. If such records are identified, then obtain those records and associate them with the electronic claims file. To expedite this action, the Veteran is encouraged to submit any additional VA or private medical records in his possession. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected trigeminal cranial nerve neuropathy. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should indicate the cranial nerves affected and severity (“degree of paralysis”), basing the responses on symptoms and findings from muscle strength and sensory testing. The examiner should ensure that the paralysis affecting cranial nerve V (trigeminal) is addressed in the examination report. The Board notes that the Veteran’s trigeminal cranial nerve neuropathy was previously found to be productive of moderate incomplete paralysis of cranial nerve V. If any current findings contradict the previous “moderate” severity characterization, the examiner must address that discrepancy in the examination report. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. L. Marcum, Counsel