Citation Nr: 18148388 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 11-09 439 DATE: November 8, 2018 ORDER Entitlement to an extension of a temporary total 100 percent rating following spinal surgery for a service-connected cervical spine disability is granted, effective July 17, 2008 through August 11, 2008. From August 12, 2008 forward, entitlement to a rating of 30 percent for a cervical spine disability, but no higher, is granted. A rating of 20 percent for a lumbar spine disability, but no higher, is granted. An initial rating in excess of 20 percent for left upper radiculopathy is denied. An initial rating in excess of 20 percent for right upper radiculopathy is denied. An initial rating in excess of 10 percent for left lower radiculopathy is denied. An effective date prior to January 1, 2013 for service connection for right upper extremity radiculopathy is denied. An effective date prior to June 29, 2017 for service connection for left lower extremity radiculopathy is denied. Entitlement to special monthly compensation for housebound status after January 1, 2010 is denied. FINDINGS OF FACT 1. The Veteran’s spinal surgery for his cervical spine disability required convalescence from July 17, 2008, the date of his claim, through August 11, 2008. 2. Resolving reasonable doubt in the Veteran’s favor, from August 12, 2008 forward, his cervical spine disability has been manifested by forward flexion less than 30 degrees. 3. Resolving reasonable doubt in the Veteran’s favor, his lumbar spine disability has been manifested by combined range of motion not greater than 120 degrees. 4. The Veteran’s left upper radiculopathy was not manifested by moderate paralysis. 5. The Veteran’s right upper radiculopathy was not manifested by moderate paralysis. 6. The Veteran’s left lower radiculopathy was not manifested by moderate paralysis. 7. The preponderance of evidence is against finding that the date entitlement arose for service connection for right upper radiculopathy was prior to January 4, 2013. 8. The preponderance of evidence is against finding that the date entitlement arose for service connection for left lower extremity radiculopathy was prior to June 28, 2017. 9. After January 1, 2010, the Veteran did not have a service-connected disability rated as total, and his award of a total rating based on individual unemployability (TDIU) was not based on a single service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a temporary total 100 percent rating is warranted for spinal surgery for a cervical spine disability from July 17, 2008 through August 11, 2008. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.400(o), 4.1, 4.3, 4.7, 4.30. 2. From August 12, 2008 forward, the criteria for a rating of 30 percent, but no higher, for a cervical spine disability have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 3. The criteria for a rating of 20 percent, but no higher, for a lumbar spine disability have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 4. The criteria for a rating in excess of 20 percent for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8513. 5. The criteria for a rating in excess of 20 percent for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8511. 6. The criteria for a rating in excess of 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8720. 7. The criteria for an earlier effective date for the grant of service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 8. The criteria for an earlier effective date for the grant of service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. The criteria SMC at the housebound rate are not met for the period beyond January 1, 2010. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1990 to July 1996. In various submissions, the attorney-representative directed the Board to focus on the appellate period prior to the effective date of the grant of TDIU; to ensure full consideration of the issues in appellate status, the Board will consider the time period from the effective date of this TDIU award forward. 1. Extension of a temporary total 100 percent rating The Veteran contends that he was prescribed convalescence following surgery from June 17, 2008 to August 11, 2008. A total rating (100 percent) for convalescence will be assigned when it is established that entitlement is warranted, effective from the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. 38 C.F.R. § 4.30. Extensions of 1, 2, or 3 months beyond the initial 3 months may be made for a total of six months. 38 C.F.R. § 4.30(b)(1). Extensions of 1 or more months up to 6 months beyond this initial 6 month period may be made upon a determination that there exist severe residuals under Section 4.30(a)(2) or immobilization by cast under Section 4.30(a)(3). 38 C.F.R. § 4.30(b)(2). Severe postoperative residuals includes, but are not limited to, incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, or the necessity for continued use of a wheelchair or crutches. 38 C.F.R. § 4.30(a)(2). The Veteran is currently assigned a temporary 100 percent rating for convalescence purposes from July 17, 2008 through July 31, 2008. 38 C.F.R. § 4.30. In an August 2011 correspondence, the Veteran submitted a form entitled “Patient Surgery Information” from his private neurosurgeon. This document indicated that the Veteran’s surgery date was June 17, 2008. [The Board notes that the date of this spinal surgery is supported by other private medical documents in the record.] The correspondence also enclosed a doctor’s release from the private neurosurgeon indicating that the Veteran would be sufficiently recovered and able to return to work on August 11, 2008. No other evidence of record is suggestive of the required duration of convalescence for the Veteran, beyond that already discussed. The Board notes that the Veteran cannot obtain a benefit prior to the date of the receipt of his claim. His claim was received on July 17, 2008. Hence, no rating can occur prior to July 17, 2008. See 38 C.F.R. § 3.400(o). Consequently, resolving all doubt in the Veteran’s favor, the Board finds that the Veteran’s convalescence lasted from July 17, 2008, the date of claim, through August 11, 2008. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The rating 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. Increased Rating: Spine Claims The Veteran’s service-connected cervical spine disability has been rated as 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5243; and his serviced-connected lumbar spine disability has been rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Diagnostic Code 5243 provides that intervertebral disc syndrome (preoperatively or postoperatively) be rated either under the General Rating Formula for Disease and Injuries of the Spine, or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. In this case, there is no evidence suggestive of incapacitating episodes to warrant a compensable rating, and thus the General Rating Formula for Disease and Injuries of the Spine will be applied to the Veteran’s cervical spine disability. Under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5243 and 5237, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: A 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 through 5243. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See General Rating Formula for Diseases and Injuries of the Spine, Note 5.   2. Cervical spine Based on review of the evidentiary record, the Board finds that the Veteran’s cervical spine disability is best approximated by forward flexion less than 30 degrees throughout the pendency of the appeal. An October 2010 Social Security Administration Internal Medicine Evaluation reported cervical spine flexion of 40 degrees. A January 2011 private note from VC reported cervical spine flexion of 15 degrees. A February 2011 private note from VC reported cervical spine flexion of 10 degrees. A January 2013 VA examination reported cervical spine flexion of 20 degrees, with painful motion beginning at 5 degrees. In addition, the Veteran reported flare-ups resulting in pain in the neck, shoulders, and arms. An April 2016 VA physical therapy consult note indicated cervical spine flexion of 30 degrees. Considering the evidence above, the Board finds that given the fluctuations in the severity of his cervical spine symptomatology during the period from August 12, 2008 forward, his symptoms more nearly approximate the criteria for a 30 percent rating. Therefore, resolving all doubt in the Veteran’s favor a disability rating of 30 percent is warranted during this period. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3, 4.7. However, the Board does not find that a rating higher than 30 percent can be assigned at any time during the pendency of the appeal. A higher rating cannot be assigned unless the Veteran’s cervical spine demonstrates unfavorable ankylosis. The preponderance of the evidence shows that he has not had, at any time during the period on appeal, unfavorable ankylosis of the cervical spine or symptoms analogous to unfavorable ankylosis. Moreover, the Veteran is already in receipt of separate compensable ratings for his associated neurological impairments, and therefore his complaints of flare-ups in his upper extremities do not serve as a basis for an increase rating. The Board has also considered the Veteran’s and other laypersons’ statements regarding symptoms such as neck pain and stiffness. The Board notes the Veteran and these laypersons are competent to report observable symptomatology. However, as to the specific issue in this case, questions of nature and medical severity fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, to the extent the Veteran and other laypersons are addressing questions of the medical nature and severity of his cervical spine disability, the Board finds these statements are not competent evidence, and therefore the objective medical evidence outweighs these lay statements. Accordingly, resolving reasonable doubt in the Veteran’s favor, a rating of 30 percent, but no higher, for the Veteran’s service-connected cervical spine is warranted from August 12, 2008 forward. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Lumbar spine Based on review of the evidentiary record, the Board finds that the Veteran’s lumbar spine disability is best approximated by a combined range of motion of not greater than 120 degrees throughout the pendency of the appeal. In November 2008 the Veteran underwent a VA examination for his lumbar spine. The Veteran reported that his low back pain flares with increasing pain and last variable lengths of time. The Veteran reported that his pain limited his activity, for example, he could not bend forward at the waist, and he could not stand or walk for more than two hours or carry more than 30 pounds. There was no report of 24-hour incapacitation. The low back was not tender. Range of motion of the lumbar spine was: forward flexion to 90 degrees with pain on recovery, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 40 degrees, left lateral rotation to 40 degrees. This resulted in a combined range of motion of 220 degrees. A March 2011 VA examination reported that range of motion of the lumbar spine was: forward flexion to 20 degrees with pain, extension to 20 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 20 degrees, left lateral rotation to 20 degrees. This resulted in a combined range of motion of 100 degrees. In June 2017, the Veteran was provided a VA examination. He reported experiencing flare-ups that he described as his “back giving out.” The examination was being conducted during a flare-up. Range of motion testing for the lumbar spine throughout the examination, including with three repetitions, was: forward flexion to 75 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, left lateral rotation to 20 degrees. This resulted in a combined range of motion of 175 degrees. Also, in June 2017, a VA examiner was asked to opine on limitations due to flare-ups reported by the Veteran at the November 2008 VA examination. She responded that estimating limited range of motion due to flare-ups would be speculative given how old the examination was. Considering the evidence above, the Board finds that the Veteran’s lumbar spine symptomatology more nearly approximates the criteria for a 20 percent rating. In reaching this decision, the Board has considered that a retrospective medical opinion regarding flare-ups is highly unlikely and that the June 2017 VA examination was being conducted during a flare-up. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). As such, the Board will resolve all reasonable doubt in favor of the Veteran, and finds that based on the combined range of motion during the March 2011 VA examination that a 20 percent rating, but no higher, is warranted throughout the pendency of the appeal. The Board has considered and finds that the 40 percent rating criteria do not apply based on the Veteran’s overall disability picture. While the March 2011 VA examination reported forward flexion of 20 degrees with pain, this one report alone, does not warrant a higher rating. Instead, the evidence more often showed forward flexion greater than 30 degrees, and therefore the disability picture is best approximated by the Veteran’s combined range of motion. Moreover, no higher rating can be assigned unless the Veteran’s lumbar spine demonstrates unfavorable ankylosis. The preponderance of the evidence shows that he has not had, at any time during the period on appeal, unfavorable ankylosis of the lumbar spine or symptoms analogous to unfavorable ankylosis. The Board has also considered the Veteran’s statements regarding symptoms such as low back pain. The Board notes the Veteran is competent to report observable symptomatology. However, as to the specific issue in this case, questions of nature and medical severity fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, to the extent the Veteran and other laypersons are addressing questions of the medical nature and severity of his lumbar spine disability, the Board finds these statements are not competent evidence, and therefore the objective medical evidence outweighs these lay statements. Accordingly, resolving reasonable doubt in the Veteran’s favor, a rating of 20 percent, but no higher, for the Veteran’s service-connected lumbar spine is warranted throughout the appeal. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating: Peripheral Nerve Claims For the upper extremities, handedness for purposes of the dominate rating criteria is considered by the evidence of records or VA examination. See 38 C.F.R. § 4.69. Based on VA examination, the Veteran is right handed. The Veteran’s serviced-connected left upper extremity radiculopathy has been rated as 20 percent disabling under Diagnostic Code 8513 and his service-connected right upper extremity radiculopathy has been rated as 20 percent disabling under Diagnostic Code 8511. For the minor extremity, Diagnostic Code 8513 provides a 20 percent rating for mild incomplete paralysis, a 30 percent rating for moderate incomplete paralysis, a 60 percent rating for severe incomplete paralysis, and an 80 percent rating for complete paralysis of all radicular group nerves. 38 C.F.R. § 4.124a. For the major extremity, Diagnostic Code 8511 provides a 20 percent rating for mild incomplete paralysis, a 40 percent rating for moderate incomplete paralysis, and a 50 percent rating for severe incomplete paralysis of the middle radicular group. Where there is complete paralysis, as manifested by adduction, abduction and rotation of the arm, flexion of elbow, and extension of the wrist lost or severely affected, a 70 percent rating is assigned for the minor extremity. 38 C.F.R. § 4.124a. The Veteran’s service-connected left lower extremity radiculopathy has been rated as 10 percent disabling under Diagnostic Code 8720. Diagnostic Code 8720 provides a 10 percent rating for mild incomplete paralysis, a 20 percent rating for moderate incomplete paralysis, a 40 percent rating for moderately severe incomplete paralysis, and a 60 percent rating for severe incomplete paralysis with marked muscular atrophy of the sciatic nerve. An 80 percent rating is assigned for complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. Disability ratings with respect to neurological conditions ordinarily are assigned in proportion to the impairment of motor, sensory, or mental function. 38 C.F.R. § 4.12. Therefore, when rating peripheral nerve injuries attention is given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory. Id. Special consideration is given to complete or partial loss of use of one or more extremities and disturbances of gait. 38 C.F.R. § 4.124a. The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a; Note prefacing Diagnostic Codes 8510 through 8730. Terms such as “mild,” “moderate,” and “severe” are not defined in the rating schedule. Rather than applying a mechanical formula, VA must evaluate all the evidence so that its decisions are equitable and just. See 38 C.F.R. §§ 4.2, 4.6. 4. Left upper extremity radiculopathy The Veteran has appealed his initial rating for left upper extremity radiculopathy; however, neither he nor his attorney-representative have made specific allegations regarding why its severity is more than mild incomplete paralysis. Throughout the appeal period, based on the January 2013 VA examination, the Board finds that the Veteran’s right upper extremity radiculopathy involving the median nerve, ulnar nerve, and the musculocutaneous nerve, resulted in mild incomplete paralysis. While private and VA treatment records include complaints of left upper extremity radiculopathy, there is no indication of its severity. Moreover, the March 2011 VA examination found no left upper extremity neurologic abnormalities. Consequently, the Board finds that the most probative evidence of record is the January 2013 VA examination, as it is the only medical opinion of record. Consequently, the Board adopts the opinion of the VA examiner, who ultimately found that the Veteran’s left upper extremity radiculopathy resulted in mild incomplete paralysis. Neither the Veteran nor his attorney-representative have presented or identified any contrary medical opinion or treatment that supports his claim. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In sum, the Board finds that the preponderance of the evidence is against this claim, and a rating in excess of 20 percent is not warranted at any time during the pendency of the appeal. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Right upper extremity radiculopathy The Veteran has appealed his initial rating for right upper extremity radiculopathy; however, neither he nor his attorney-representative have made specific allegations regarding why its severity is more than mild incomplete paralysis. The January 2013 examiner found right upper extremity radiculopathy involving the median nerve, ulnar nerve, and the musculocutaneous nerve, resulted in mild incomplete paralysis. Prior to this examination, as set forth in more detail in Section 7 below, there is no indication of complaints of right upper extremity radiculopathy. Consequently, the Board finds that the most probative evidence of record is the January 2013 VA examination, as it is the only medical opinion of record. Consequently, the Board adopts the opinion of the VA examiner, who ultimately found that the Veteran’s right upper extremity radiculopathy resulted in mild incomplete paralysis. Neither the Veteran nor his attorney-representative have presented or identified any contrary medical opinion or treatment that supports his claim. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In sum, the Board finds that the preponderance of the evidence is against this claim, and a rating in excess of 20 percent is not warranted at any time during the pendency of the appeal. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.   6. Left lower extremity radiculopathy The Veteran has appealed his initial rating for left lower extremity radiculopathy; however, neither he nor his attorney-representative have made specific allegations regarding why its severity is more than mild incomplete paralysis. The June 2017 VA examiner found left lower extremity radiculopathy, involving the sciatic nerve, that resulted in mild incomplete paralysis. There is no support in the medical treatment records that the Veteran left lower extremity radiculopathy was more severe than rated on examination. The Board finds that the most probative evidence of record is the June 2017VA examination, as it is the only medical opinion of record. Consequently, the Board adopts the opinion of the VA examiner, who found that the Veteran’s left lower extremity radiculopathy was mild in nature. Neither the Veteran nor his attorney-representative have presented or identified any contrary medical opinion or treatment that supports an increased rating. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In sum, the Board finds that the preponderance of the evidence is against this claim, and a rating in excess of 10 percent is not warranted at any time during the pendency of the appeal. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Earlier Effect Date Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5100; 38 C.F.R. § 3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400(b)(2). Otherwise, it is the date of receipt of claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. 7. Right upper extremity radiculopathy The Veteran filed an informal claim for service connection for bilateral upper extremity radiculopathy, which was received on July 17, 2008. See 38 C.F.R. § 3.155 (2014). The date entitlement arose means the date the disability was shown to be present and entitlement was warranted under the law, based on any raised theory. While the term “date entitlement arose” is not defined in the current statute or regulation, the Court has interpreted it as the date when the claimant met the requirements for the benefits sought. This is determined on a “facts found” basis. See 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000); see also DeLisio v. Shinseki, 25 Vet. App. 45, 56 (2011) (holding “entitlement to benefits for a disability or disease does not arise with a medical diagnosis of the condition, but with the manifestation of the condition and the filing of a claim for benefits for the condition”); but see Brammer v. Derwinski, 3 Vet. App. 223 (1992) (in the absence of proof of a current disability there can be no valid claim). The evidence indicates that the date entitlement arose for right upper extremity radiculopathy was not until the January 2013 VA examination. Prior to that time, there is no indication of neurologic abnormalities of the right upper extremity. The VA cervical spine examination in March 2011 found no neurologic abnormalities. In addition, medical examinations furnished by SSA contained no findings as to right upper extremity radicular symptoms or complaints. Similarly, treatment records associated with the claims file do not support complaints, diagnosis, or treatment of right upper extremity radicular symptoms prior to January 4, 2013. To the contrary, private and VA medical records only contained complaints of left upper extremity radicular symptoms. Hence, while the Veteran did file an informal claim for bilateral upper extremity radiculopathy, there were no reported manifestations of right upper extremity radiculopathy until January 4, 2013. Since the pertinent regulation specifically states that the effective date must be the later date, the grant of service connection can be no earlier than January 4, 2013. See 38 C.F.R. § 3.400. In reaching this conclusion, the Board acknowledges that the medical evidence of record indicates prescription medication for nerve pain and treatment notes that generally reported radicular symptoms. However, this evidence is too vague to establish a current disability or symptom manifestation of right upper extremity radiculopathy because this evidence could very well be referring to the Veteran’s left upper extremity radiculopathy (a condition well-documented in the medical treatment evidence). In weighing the evidence of record, the Board gives more weight to the objective examination findings of trained VA examiners conducted during the pendency of the appeal to ascertain the existence of peripheral nerve conditions, over generalized and nonspecific indications of nerve pain in the treatment records. See Schoolman v. West, 12 Vet. App. 307 (1999); see also Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty); Obert v. Brown, 5 Vet. App. 30 (1993) (medical opinions that are speculative, general, or inconclusive in nature cannot support a claim). Less weight is appropriate for this generalize evidence in light of the objective VA examination findings and the absence of complaints of right upper extremity radicular symptoms prior to January 4, 2013. The Board disagrees with the attorney-representative’s characterization in the various Notice of Disagreements that the Veteran’s upper extremity radiculopathy was “bilateral in nature.” There is no evidence of right upper extremity radicular symptoms or complaints until the January 2013 VA examination. The Board will not substitute its own judgment or the lay judgment of the attorney-representative, in determining whether an appropriate diagnosis was made by trained medical professionals during the pendency of the appeal based on the Veteran’s subjective complaints and objective testing. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (holding that “BVA panels may consider only independent medical evidence to support their findings”). In sum, the Board finds that the preponderance of the evidence is against this claim, and there is no basis for an effective date prior to January 4, 2013 and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 8. Left lower extremity radiculopathy The Veteran did not file a formal or informal claim for left lower extremity radiculopathy. Rather this was an inferred claim for service connection based upon the findings during the June 2017 VA examination. The June 2017 VA examiner found left lower extremity radiculopathy. Prior to that date, there were no complaints or symptoms of left lower extremity radiculopathy in the medical evidence. See, e.g., November 2008 VA examination (“no radicular complaints regarding his low back”); January 2013 VA peripheral nerve examination (no findings of neurologic abnormalities affecting the lower extremities). As there is no evidence of VA receipt of a claim, formal or informal, for service connection for left lower extremity radiculopathy, the award of service connection for such disability may be no earlier than June 29, 2017, the date left lower extremity radiculopathy was found during the VA examination. See 38 C.F.R. § 3.400; see also Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). In sum, the Board finds that the preponderance of the evidence is against this claim, and there is no basis for an effective date prior to June 29, 2017 and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Special Monthly Compensation 9. Housebound rate The Veteran contends that SMC at the housebound rate, or “statutory housebound,” should be extended beyond January 1, 2010. SMC at the housebound rate was awarded from July 14, 2009 to January 1, 2010 due to the Veteran’s temporary total rating following left knee surgery. When a Veteran has a single disability rated totally disabling, and additional disabilities independently rated at a combined 60 percent disabling or more, regulations provide for the payment of SMC at the housebound rate. 38 C.F.R. § 3.350(i). There is no need to establish factually that the Veteran’s service-connected disabilities confined him to his dwelling, as this has not been raised by the evidence nor contended by the Veteran and his attorney-representative. Following this convalescence period, the Veteran does not have a service-connected disability rated as total. Therefore, SMC at the housebound rate is not available as a matter of law. Moreover, SMC is not available after the grant of TDIU, which became effective on August 24, 2011, because TDIU was granted due to the combined effects of the Veteran’s service connected disabilities and not a singular disability. See July 2017 rating decision (awarding TDIU for musculoskeletal conditions affecting the neck, back, and knees with neural deficits); July 2014 Notice of Disagreement at p. 2 (arguing TDIU was warranted due to impairment of the neck, low back, right knee and associated radiculopathy); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010) (TDIU based on more than one disability does not satisfy the requirement under 38 U.S.C. § 1114(s) that a claimant have a “service-connected disability rated as total”); cf. Bradley v. Peake, 22 Vet. App. 280, 294 (2008) (veteran had been granted TDIU for only one disability, and had subsequently obtained service connection for multiple orthopedic disabilities that combined to 60 percent). Accordingly, the criteria for SMC at the housebound rate are not met and the claim must be denied. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). 10. Extraschedular consideration In the September 2018 brief, the attorney-representative contends that extraschedular consideration should be considered for any period where the Veteran does not satisfy the full schedular criteria in the above increased rating claims. Based on thorough review of the record the Board finds that extraschedular consideration is inappropriate throughout the pendency of the appeal. The Board has considered whether the Veteran’s disability presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral for extraschedular ratings is warranted. See 38 C.F.R. § 3.321(b)(1); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor is whether the disability picture presented in the record is adequately contemplated by the rating schedule. Thun v. Peake, 22 Vet. App. 111, 118 (2008). The attorney-representative has made no specific allegations as to how or why he believes that extraschedular consideration is appropriate. There is no suggestion in the medical evidence that the Veteran’s disability picture is not adequately contemplated by the rating schedule. Here, as detailed in the decision above, the rating criteria reasonably describe the Veteran’s disability level and symptomatology.   The Veteran’s cervical spine, lumbar spine, and peripheral nerve disabilities manifest with pain and limitation of motion, which are addressed in their respective rating criteria. As his disability picture is contemplated by the rating schedule, the assigned schedular ratings are adequate. Accordingly, referral for extraschedular consideration is not warranted. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Dellarco, Associate Counsel