Citation Nr: 18153013 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 14-25 231A DATE: November 27, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for an anxiety disorder, as secondary to TBI, is denied. Prior to August 2, 2017, entitlement to a rating in excess of 10 percent for cervical spine degenerative disc disease with spondylosis is denied. From August 2, 2017, entitlement to a rating in excess of 20 percent for cervical spine degenerative disc disease with spondylosis is denied. Entitlement to a compensable rating for a traumatic brain injury (TBI) is denied. Entitlement to a rating of 40 percent for right upper extremity radiculopathy associated with cervical degenerative disc disease is granted. Entitlement to an effective date, prior to July 29, 2014, for the award of service connection for tinnitus is denied. Entitlement to TDIU is denied. FINDINGS OF FACT 1. There is no competent evidence that the Veteran has bilateral hearing loss for VA compensation purposes. 2. The Veteran’s anxiety is neither proximately due to nor aggravated beyond its natural progression by his service-connected TBI, and is not otherwise related to an in-service injury, event, or disease. 3. Prior to August 2, 2017, the Veteran’s cervical degenerative disc disease with spondylosis has been manifested by forward flexion of the cervical spine greater than 30 degrees, but not greater than 40 degrees, but not by forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the Veteran did not have IVDS resulting in incapacitating episodes over the past 12 months. 4. Beginning August 2, 2017, the Veteran’s cervical degenerative disc disease with spondylosis has been manifested by forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, but not by forward flexion of the cervical spine to 15 degrees or less or favorable ankylosis of the entire cervical spine; the Veteran did not have IVDS resulting in incapacitating episodes over the past 12 months. 5. The Veteran’s residuals of a TBI disability has been manifested by no more than Level 0 impairment of any cognitive function. 6. The Veteran’s right upper extremity radiculopathy was manifested by incomplete paralysis that resulted in moderate severity. 7. There is no legal or factual basis for an effective date earlier than July 29, 2014, for the grant of service connection for tinnitus. 8. The Veteran does not meet the schedular requirements for a TDIU, and the Veteran’s service-connected disabilities do not otherwise prevent him from obtaining or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for anxiety are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310(a). 3. Prior to August 2, 2017, the criteria for a rating in excess of 10 percent for cervical degenerative disc disease with spondylosis have not been met or approximated. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 4. From August 2, 2017, the criteria for a rating in excess of 20 percent for cervical degenerative disc disease with spondylosis have not been met or approximated. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 5. The criteria for entitlement to a compensable rating for residuals of a TBI have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7; 4.124a, Diagnostic Code 8045. 6. Resolving all reasonable doubt in the Veteran’s favor, the criteria for a rating of 40 percent for right upper extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.14, 4.124a, Diagnostic Codes 8510. 7. The criteria for an effective date earlier than July 29, 2014, for the grant of service connection for tinnitus are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.155, 3.400, Diagnostic Code 6260. 8. The criteria for a TDIU have not been met. 38 U.S.C. § 1155, 7104; 38 C.F.R. §§ 3.321, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1983 to April 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. 3.303 (a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2008); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). A Veteran seeking service connection must establish the existence of a disability and a connection between the service and the disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Entitlement to service connection for bilateral hearing loss. The Veteran contends that service connection is warranted for bilateral hearing loss. For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. The Court has held that “the threshold for normal hearing is from 0 to 20 dB [decibels], and higher threshold levels indicate some degree of hearing loss.” Hensley v. Brown, 5 Vet. App. 155, 157 (1993). At the outset, although the Veteran’s service treatment records do not show any complaints of or treatment for hearing loss, the Board notes that the Veteran’s MOS in service was that of an Apprentice Airlift Aircraft Maintenance Specialist, which the VA has conceded has a high probability of noise exposure. The Veteran was afforded a VA examination in June 2012. The examiner noted that the Veteran had normal hearing bilaterally and that he did not have a hearing disability for VA purposes. The examiner also opined that the Veteran did not have hearing loss in service. In the functional impact section of the examination report, the examiner noted that the Veteran’s hearing loss impacted the Veteran’s ordinary conditions of daily life. However, the examiner noted the Veteran’s subjective reports that he has difficulty communicating in social and employment situations. The Veteran was afforded another VA examination in July 2014. The examiner noted that the Veteran had in-service noise exposure as a crew chief and that he denied recreational noise exposure, a family history of hearing loss, and a history of ear disease. The examiner noted that the Veteran had normal hearing bilaterally and that he did not have a hearing disability for VA purposes. Because the Veteran did not have a documented disability, no etiology opinion was provided. While the Veteran reports problems with hearing, and he is competent to report those problems, he is not competent to report that his hearing loss meets the minimum thresholds for a hearing loss disability under the VA regulations set forth at 38 C.F.R. § 3.385. A review of the Veteran’s VA treatment records did not otherwise reveal clinical findings of hearing loss for VA purposes. Notably, in an April 2016 primary care outpatient note, it was noted that there was no change in hearing and no decreased hearing bilaterally. Here, service connection is denied, as there is no evidence that the Veteran has a current hearing loss disability for VA purposes. Moreover, presumptive service connection is also denied as there is no evidence that hearing loss manifested to a compensable degree within a year of the Veteran’s separation from active duty. The Veteran has not provided any medical evidence to the contrary. Given these findings, particularly the lack of any competent evidence of a hearing loss disability, the claim is denied. In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for anxiety, as secondary to TBI. The Veteran contends that service connection is warranted for anxiety, as secondary to TBI. The Veteran’s service treatment records are silent as to complaints, treatment, or a diagnosis of a psychiatric disorder, to include anxiety. Further, the Veteran’s March 1985 separation examination was silent as to any mental illnesses. The Veteran’s VA treatment records show that the onset of the Veteran’s anxiety was following service and was in relation to situational stressors. In a February 2012 private treatment record, it was noted that the Veteran reported multiple increased social stressors, to include a layoff, economic stressors, health issues, his mother moving in with him, and the death of a pet. In a February 2013 private treatment record, authored by C.A., the clinician noted a diagnosis of anxiety disorder NOS. The clinician stated that the Veteran’s recent abrupt symptoms onset suggests recent cessation of regular cannabis and oxycodone use as causative factors, which was also complicated by his brother’s death at a young age. The Veteran was afforded a VA examination in July 2014. At the time of the examination, the Veteran denied significant symptoms associated with anxiety or depression, to include decreased interest, decreased motivation, decreased energy, chronic worry or anxiety, helplessness, hopelessness, and decreased energy. The Veteran reported intermittent concentration difficulties and stated that he daydreams at times. He stated that his memory had worsened; he denied suicidal or homicidal ideation. The examiner diagnosed the Veteran with having other specified anxiety disorder, resolved. The examiner opined that it was less likely than not related to his TBI. The examiner also stated that the Veteran had never been treated for mental health issues during military service. The Veteran was afforded another VA examination in January 2018. The examiner diagnosed the Veteran with an unspecified anxiety disorder. The examiner opined that the Veteran’s anxiety was neither secondary to, nor aggravated by, his service-connected TBI. The examiner also noted that there was no evidence of this disability during service. To summarize, the rationale provided for the opinion was that there was no evidence that the Veteran had cognitive or psychiatric residuals related to his in-service concussion and resulting TBI. Further, there was no evidence to support his anxiety disorder being related to his mild TBI and no evidence of any cognitive or psychiatric residuals secondary to his mild concussion. The examiner also noted that the Veteran’s separation examination was silent as to any residuals secondary to a TBI and that the Veteran’s VA records documented onset post-military service and in relation to situational stressors. Based on the evidence of record, the Board finds that service connection for anxiety is not warranted. Initially, the Board finds that there is no competent or credible evidence directly linking the Veteran’s anxiety disorder to service. Moreover, the January 2018 VA examiner determined that the Veteran’s anxiety was not proximately due to, caused by, or aggravated beyond its natural progression by his service-connected TBI. The examiner also offered a detailed rationale for such opinion. No other medical opinion of record refutes the examiner’s opinion. The Board has also considered the Veteran’s statements that he believes his anxiety is due to his service-connected TBI. However, given that the Veteran does not have any special medical expertise, the Board must find that he is not competent to give a medical opinion on this issue. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). As such, the opinion of the VA examiner, a medical professional, is more probative than the Veteran’s lay statements. Thus, his statements are outweighed by highly probative VA opinion. In conclusion, based on the analysis above, a preponderance of the evidence is against the Veteran’s claim for service connection for anxiety. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107 (b). Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). It is also noted that staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Entitlement to increased ratings for cervical degenerative disc disease with spondylosis The Veteran’s service-connected cervical degenerative disc disease with spondylosis is rated under the criteria contained in 38 C.F.R. § 4.124a, Diagnostic Code 5242, for degenerative arthritis of the spine. The Veteran contends that a rating in excess of 10 percent is warranted prior to August 2, 2017 and in excess of 20 percent thereafter. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes). The General Rating Formula for Diseases and Injuries of the Spine provides that a 10 percent evaluation is to be assigned for forward flexion of the cervical spine greater than 30 degrees, but not greater than 40 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 spinal contour, or vertebral facture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 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 evaluation is warranted for forward flexion of the cervical spine to 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted for unfavorable ankylosis of the entire cervical spine. The Notes following the General Rating Formula provide further guidance in rating diseases or injuries of the spine. Note 1 specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note 2 states that, for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note 3 provides that in exceptional cases, an examiner may state that because of age, body habitus, neurological disease, or other factors not the result of disease or injury of the spine, the range of motion of spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note 2. Provided that the examiner provides an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note 4 provides that range of motion measurements are to be rounded to the nearest five degrees. Note 5 defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire the 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. Under the Formula for Rating IVDS Based on Incapacitating Episodes (in pertinent part) a 20 percent disability rating is warranted with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is warranted with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent disability rating is warranted with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) for purposes of evaluations under the Formula for Rating IVDS Based on Incapacitating Episodes, defines an incapacitating episode as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59 (2006); see also Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). The possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. §§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). See Mitchell, supra. Prior to August 2, 2017 The Veteran contends that a rating in excess of 10 percent is warranted prior to August 2, 2017. The Veteran’s VA treatment records reveal that the Veteran has neck pain. However, the records do not contain information about range of motion, muscle spasm, or guarding on which to evaluate his neck. In a July 2013 private cervical spine impairment questionnaire, authored by Dr. D.S., the clinician noted that the Veteran experiences pain between 30 and 40 degrees. No ankylosis, swelling, muscle atrophy, muscle weakness, crepitus, or reflex changes were noted. The clinician noted that the Veteran had sensory loss in the right trapezius region, as well as tenderness in the upper and lower left spine. The clinician also noted that the Veteran had muscle spasms, which occurred twice a week. As to the muscle spasms, there was no notation that such was severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The Veteran was afforded a VA examination in July 2013, at which time the Veteran was diagnosed with cervical degenerative disc disease, cervical spondylosis without clinical evidence of radiculopathy. The Veteran denied flare-ups. Range of motion testing revealed forward flexion of 45 degrees or greater, with painful motion beginning at 40 degrees. The combined range of motion was 295 degrees. The Veteran was able to perform repetitive use testing, with no additional limitation in range of motion. The Veteran had functional loss and/or functional impairment, with contributing factors of less movement than normal and pain on movement. Muscle strength testing was normal. The Veteran did not have muscle atrophy. The Veteran’s reflex examination was normal. There were no neurological abnormalities or findings of IVDS. There were no other pertinent findings, complications, conditions, signs, or other symptoms. The Veteran was afforded a VA examination in May 2014. The examiner diagnosed the Veteran with cervical degenerative disc disease, spondylosis and mild right C5 radiculopathy, sensory only. The Veteran reported increasing pain in his neck region, with radiating pain/numbness and pins-and-needles sensations to his right upper arm and forearm. The Veteran also reported difficulty at work and missed days due to his neck pain. The Veteran also reported daily pain of an achy/sharp type and an average pain level of 4/10 which increases at the end of the work day, as well as flare-ups which occurred three to four times a month which made it difficult for him to move his neck. Range of motion testing showed forward flexion to 45 or greater degrees, with objective evidence of pain at 35 degrees. The Veteran’s total range of motion was 280 degrees. The Veteran had localized tenderness or pain to palpation for joints/soft tissue of the cervical spine. The Veteran did not have muscle spasms or guarding. Muscle strength testing was normal; there was no muscle atrophy. Reflex testing was normal. Sensory exam testing was normal, with the exception of the right shoulder (C5) which showed decreased sensation. There was no ankylosis or other neurological abnormalities. The Veteran had IVDS of the cervical spine, but did not have any incapacitating episodes over the past 12 months. The examiner noted that the Veteran’s condition impacted his ability to work in that the Veteran reported that he missed two to three days of work per month due to his neck pain and that he was unable to extend his neck during flare-ups. Here, a 20 percent rating is not warranted under Diagnostic Code 5242 prior to August 2, 2017. There is no lay or medical evidence conclusively demonstrating forward flexion of the cervical spine greater than 15 degrees but not greater than 30 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. In light of the foregoing, the Board concludes that the Veteran’s symptoms affecting the cervical spine more closely approximate that of the criteria for a 10 percent rating prior to August 2, 2017. The Veteran has reported chronic neck pain and thus, the Board recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. However, higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant a rating in excess of 10 percent during this period. At the VA examinations, the examiner found that there was no additional restricted range of motion following repetitive use. Moreover, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, does not itself constitute functional loss. Mitchell, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 11; see 38 C.F.R. § 4.40. In this case, it does not. Therefore, a rating in excess of 10 percent is not warranted based on limitation of motion during this period Additionally, while the May 2014 VA examiner reported that the Veteran had IVDS, the examiner also further found that the Veteran had no incapacitating episodes over the past 12 months. Also, the Veteran’s outpatient VA treatment records are silent for any notations of IVDS or incapacitating episodes, and the Veteran has not indicated that he suffers from incapacitating episodes as contemplated by the Incapacitating Episodes Formula during this period. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula, Note 1. As such, the Veteran’s cervical degenerative disc disease with spondylosis does not meet the criteria for IVDS as defined in the rating schedule. For all the foregoing reasons, the preponderance of the evidence is against a rating in excess of 20 percent beginning August 2, 2017 for cervical degenerative disc disease. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. From August 2, 2017 The Veteran contends that a rating in excess of 20 percent is warranted beginning August 2, 2017. The Veteran was afforded a VA examination in August 2017. The Veteran reported that he had nearly constant neck pain, which he rated as a 6/10 in intensity. Range of motion testing showed forward flexion to 30 degrees. The Veteran’s total range of motion was 240 degrees. The examiner noted that there was pain on extension and left lateral flexion, but there was no evidence of pain with weight bearing. The examiner noted that there was objective evidence of tenderness over the spinous processes of C6 and C7. The Veteran was able to perform repetitive use testing with at least three repetitions. Pain, weakness, fatigability, or incoordination did not significantly limit the Veteran’s functional ability. The Veteran had a moderate muscle spasm noted in the paraspinous muscles in the cervical region, but it did not result in an abnormal gait or abnormal spinal contour. There was no guarding. The Veteran had normal muscle strength; no muscle atrophy was noted. Reflex testing was normal, as was his sensory examination. There was no ankylosis. The Veteran had IVDS of the cervical spine, but did not have any episodes of acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. No assistive devices were needed. The examiner noted that it was infeasible or not medically appropriate to conduct testing for passive range of motion testing or testing the neck when it was non-weight bearing. In an August 2017 primary care note, the Veteran reported neck pain. In an unrelated January 2018 VA examination, the Veteran reported some physical concerns related to his neck. No range of motion testing was provided. Here, a 30 percent rating is not warranted under Diagnostic Code 5242 beginning August 2, 2017. There is no lay or medical evidence conclusively demonstrating 15 degrees or less of forward flexion of the cervical spine or favorable ankylosis of the entire cervical spine. In light of the foregoing, the Board concludes that the Veteran’s symptoms affecting the cervical spine more closely approximate that of the criteria for a 20 percent rating for the entire period on appeal. Moreover, even considering 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra, there has been no evidence of flexion of the cervical spine being limited to 15 degrees or less or favorable ankylosis of the cervical spine. At the August 2018 examination, flexion was to 30 degrees and did not change after repetition. Moreover, the examiner observed no objective evidence of pain on motion and clearly found no evidence of ankylosis. Although the Veteran reported flare-ups, the examiner clearly found that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran’s functional ability. In sum, the Veteran’s restrictions are adequately contemplated by the herein assigned 20 percent rating during this period. Additionally, while the August 2017 VA examiner reported that the Veteran had IVDS, the examiner also further found that the Veteran had no incapacitating episodes over the past 12 months. Also, the Veteran’s outpatient VA treatment records are silent for any notations of IVDS or incapacitating episodes, and the Veteran has not indicated that he suffers from incapacitating episodes as contemplated by the Incapacitating Episodes Formula during this period. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula, Note 1. As such, the Veteran’s cervical degenerative disc disease with spondylosis does not meet the criteria for IVDS as defined in the rating schedule. With respect to neurologic abnormalities pursuant to Note (1) of the general rating formula for disease and injuries of the spine, with the exception of right and left upper extremity radiculopathy for which the Veteran has already been awarded service connection, throughout the course of the appeal, the medical evidence fails to show any findings of neurologic abnormalities associated with the Veteran’s service-connected cervical spine disability. In this regard, there has been no objective finding of bladder or bowel dysfunction. The most recent VA examination clearly found no evidence of other associated neurological abnormalities. Thus, an additional separate rating is not warranted for any neurological symptoms. The Board acknowledges that the Veteran, in advancing this appeal, believes that the disability on appeal has been more severe than the assigned disability rating reflects. In this regard, he is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). In this case, however, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal; the medical evidence also largely contemplates the Veteran’s descriptions of symptoms. The lay evidence has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. For all the foregoing reasons, the preponderance of the evidence is against a rating in excess of 20 percent beginning August 2, 2017 for cervical degenerative disc disease. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. Entitlement to a compensable rating for a traumatic brain injury (TBI). Historically, the Veteran submitted a claim of entitlement to service connection for a TBI in August 2013. In an August 2013 rating decision, the Veteran was granted entitlement to service connection for a TBI and assigned a noncompensable rating effective August 14, 2013. The Veteran disagreed with the rating assigned and this appeal ensued. Diagnostic Code 8045 provides for the evaluation of TBI. 38 C.F.R. § 4.124a (2017). Under Diagnostic Code 8045, there are three main areas of dysfunction listed that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Adjudicators are to evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” 38 C.F.R. § 4.124a. Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Adjudicators are to evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, they are to separately evaluate any residual with a distinct diagnosis that may be evaluated under another Diagnostic Code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table. 38 C.F.R. § 4.124a. Adjudicators are to evaluate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings--mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, they are to evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” 38 C.F.R. § 4.124a. Adjudicators are to evaluate physical (including neurological) dysfunction based on the following list, under an appropriate Diagnostic Code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. 38 C.F.R. § 4.124a. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, adjudicators are to evaluate under the most appropriate Diagnostic Code. Adjudicators are to evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. 38 C.F.R. § 4.124a. The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than total," since any level of impaired consciousness would be totally disabling. Adjudicators are to assign a 100-percent evaluation if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total," adjudicators are to assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet. 38 C.F.R. § 4.124a. The evaluation assigned is based upon the highest level of severity for any facet of cognitive impairment and other residuals of traumatic brain injury not otherwise classified as determined on examination. Only one evaluation is assigned for all the applicable facets. A higher evaluation is not warranted unless a higher level of severity for a facet is established on examination. Physical and/or emotional/behavioral disabilities found on examination that are determined to be residuals of traumatic brain injury are evaluated separately. At the outset, the Board notes that the Veteran has been separately rated for headaches. By way of background, the Veteran was afforded a VA examination in July 2014. The examiner diagnosed the Veteran with a traumatic brain injury and opined that the Veteran’s TBI was at least as likely as not proximately due to or the result of an in-service injury. Upon examination, the examiner did not attribute any mental health symptoms to the Veteran’s TBI. All facets were rated as “0,” in accordance with a noncompensable evaluation. In the remarks section of the report, the examiner noted, in part, that the Veteran’s symptoms of tinnitus were not consistent with sequelae of TBI based on when the event took place and when symptoms began. The Veteran was afforded VA examinations in January 2018 to assess the severity of his condition. One examination discussed facets 1, 2, 3, 4, 6, and 8; the other discussed facets 5, 7, 9, and 10. Results from both examinations are discussed in tandem below. At the time of the examination, the Veteran reported that his only current complaint was that of memory difficulty and unrelated neck pain. On clinical evaluation, the VA examiners observed no evidence of impairment of memory, attention, concentration, executive functions, judgment, social interaction, orientation, motor activity, vision, neurobehavioral, communication, or consciousness. Turning to the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table, the Board notes that each facet was addressed in the VA TBI examination. The first facet is memory, attention, concentration and executive functions. A level of severity of “0” has been assigned for the memory, attention, concentration, and executive functions facet, indicating that there was no evidence of impairment on clinical evaluation. The Board acknowledges that there was a notation that the Veteran had difficulty focusing during the examination, but the Veteran attributed such to being ill with the flu for the past ten days. A higher level of severity of “1” is not warranted unless an examiner finds evidence of mild impairment of memory, attention, concentration, or executive functions. A level of severity of “0” has been assigned for the judgment facet, indicating that the examiner found evidence of normal judgment. A higher level of severity of “1” is not warranted unless an examiner finds evidence of mildly impaired judgment, including symptoms such as impairment for complex or unfamiliar decisions, occasional inability to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. The Veteran’s judgement was evaluated as intact during the pendency of the appeal. A level of severity of “0” has been assigned for the social interaction facet, indicating that the examiner found evidence of normal judgment. A higher level of severity of “1” is not warranted unless social interaction is occasionally inappropriate. There was no evidence of inappropriate behavior on clinical evaluation by the VA examiner. Rather, his behavior was considered appropriate during the pendency of the appeal. The Board finds that a higher level of severity of “1” for social interaction has not been shown by the evidence of record. A level of severity of “0” has been assigned for the orientation facet, indicating that the examiner found evidence that the Veteran was oriented to person, time, place, and situation. He was evaluated as alerted and oriented during clinical evaluation by the VA examiner. A higher level of severity of "1" is not warranted unless an examiner finds evidence such as occasional disorientation to one of the four aspects (person, time, place, situation) of orientation. A level of severity of “0” has been assigned for the motor activity (with intact motor and sensory system) facet, indicating normal motor activity. A higher level of severity of “1” is not warranted unless an examiner finds that motor activity is normal most of the time, but mildly slowed at times due to apraxia (in ability to perform previously learned motor activities. There is no finding of motor impairment during the pendency of the appeal. A level of severity of “0” has been assigned for the visual spatial orientation facet, indicating that the examiners found such orientation is normal. A higher level of severity of “1” is not warranted unless an examiner finds evidence of mild impairment, including occasionally getting lost in unfamiliar surroundings, having difficulty reading maps or following directions, and being unable to use assistive devices such as GPS. There is no finding of visual spatial orientation impairment during the pendency of the appeal. A level of severity of “0” is assigned for subjective symptoms facet that do not interfere with work, instrumental activities of daily living, or work, family, or other close relationships. The Veteran has not asserted that he has subjective complaints associated with his residuals of TBI that interfered with his activities of daily living as well as his work and familial relationships. A higher level of severity of “1” is not warranted unless an examiner finds evidence of three or more subjective symptoms that mildly interfere with work, instrumental activities of daily living, or work, family, or other close relationships. A level of severity of “0” has been assigned for the neurobehavioral effects facet, indicating that the examiner found no neurobehavioral impairment. A higher level of severity of “1” is not warranted unless an examiner finds one or more neurobehavioral effects. A level of severity of “0” has been assigned for the communication facet, indicating that the examiner found evidence that the Veteran is able to communicate by spoken and written language (expressive communication), and comprehend spoken and written language. A higher level of severity of “1” is not warranted unless an examiner finds comprehension or expression, or both, of either spoken language or written language that is only occasionally impaired, and that the Veteran can communicate complex ideas. Finally, for the entire period on appeal, the evidence does not indicate that the Veteran experienced a persistently altered state of consciousness, such as a vegetative state, minimally responsive state, or coma. Therefore, he does not meet a total disability rating due to his state of consciousness. In conclusion, at no point during the appeal has the evidence indicated that a compensable rating is warranted for the Veteran’s TBI under Diagnostic Code 8045. Using the table to evaluate cognitive impairment, the Veteran’s residuals have not been rated as any more than at a level “0” impairment at any point during the appeal. Using the table to evaluate subjective symptoms, the Veteran’s TBI residuals have not been characterized as any more severe than a level “0.” An assigned value of “0” yields a noncompensable evaluation, and only one evaluation may be assigned for all of the applicable facets under 38 C.F.R. § 4.124a, Diagnostic Code 8045. Therefore, an increased rating is not warranted, and the noncompensable evaluation currently assigned for the Veteran’s TBI is most appropriate for the entire period under consideration. Entitlement to a rating in excess of 20 percent for right upper extremity radiculopathy (dominant) associated with cervical degenerative disc disease. The Veteran contends that a rating in excess of 20 percent is warranted for right upper extremity radiculopathy. The Veteran’s radiculopathy disability is presently rated under Diagnostic Code 8510, concerning the evaluation of upper radicular group paralysis. Under Diagnostic Code 8510, mild incomplete paralysis is rated 20 percent disabling for both the major and minor side. Moderate incomplete paralysis is rated as 40 percent disabling on the major side and 30 percent disabling on the minor side. Severe incomplete paralysis of the radicular group is rated 50 percent disabling on the major side and 40 percent disabling on the on the minor extremity. Complete paralysis of the upper radicular group, with all shoulder and elbow movements lost or severely affected and hand and wrist movements not affected, warrants a 70 percent rating for the major side and a 60 percent rating for the minor side. 38 C.F.R § 4.124a, Diagnostic Code 8510. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture 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 is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. See 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” Words such as “moderate” and “severe” are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. Upper extremity ratings also depend on whether the disabled extremity is the major or minor extremity. The major extremity is the one predominantly used by the Veteran. Only one extremity may be considered major. 38 C.F.R. § 4.69 (2017). Here, the Veteran’s dominant hand is the right hand; thus, his right upper extremity is his major extremity. The Veteran’s VA treatment records reveal that the Veteran has radiculopathy, which is stable on medication. The records, however, do not contain details regarding the severity of the Veteran’s condition. In a July 2013 private cervical spine impairment questionnaire, authored by Dr. D.S., the clinician noted that the Veteran was diagnosed with radiculopathy as secondary to his service-connected cervical spine impairment. The clinician noted that the Veteran’s dominant hand was that of the right side. The clinician also characterized the Veteran’s right upper extremity radiculopathy as moderate in severity. The examiner also noted that the Veteran did not have any limitations in grasping, turning and twisting objects or using fingers/hands for fine manipulations; he had moderate limitations in using his arms for reaching (including overhead). The Veteran was most recently afforded a VA examination in August 2017, at which time the examiner noted that the Veteran had radiculopathy of the bilateral upper extremities. Upon examination, the examiner noted that the Veteran had radicular pain due to radiculopathy. As to the severity of his right upper extremity condition, the examiner stated that the Veteran had no constant pain, moderate intermittent pain, mild paresthesias and/or dysesthesias, and moderate numbness. The examiner noted that the Veteran had no other signs or symptoms of radiculopathy. The examiner concluded that the severity of the Veteran’s radiculopathy of the right side was moderate. Based on the findings in the July 2013 private examination, in tandem with that of the August 2017 VA examination, which both characterize the severity of the Veteran’s right upper extremity as moderate, the Board determines that the criteria for a rating of 40 percent for right upper extremity radiculopathy have been met. See 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8510. Effective Dates Generally, the effective date of an award of disability compensation is the day following separation from service or the date entitlement arose if the claim is received within one year of separation, otherwise the effective date is the date of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2). The “date entitlement arose” has been interpreted to mean the date when the claimant met the requirements for the benefits sought; this is determined on a “facts found” basis. 38 U.S.C. § 5110 (a); see also McGrath v. Gober, 14 Vet. App. 28, 35 (2000). When service connection is granted based on a claim that has been finally denied and subsequently reopened by the submission of new and material evidence, the effective date is the date of VA receipt of the new claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (q), (r); Sears v. Principi, 16 Vet. App. 244 (2002), aff’d 349 F3d 1225 (2003). A “claim” or “application” is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). An informal claim is any communication indicating intent to apply for one or more benefits. An informal claim must also be in writing. Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999); see also Szemraj v. Principi, 357 F.3d 1370 (2004) (defining when the “identification” requirement of 38 C.F.R. § 3.155 (a) is met). VA is required to look to all communications from the appellant, which may be interpreted as applications or claims, formal and informal, for benefits. In particular, VA is required to identify and act on informal claims for benefits. 38 U.S.C. § 5110 (b)(3); 38 C.F.R. §§ 3.1 (p), 3.155(a); see Servello v. Derwinski, 3 Vet. App. 196 (1992). The date of receipt is the date when a claim, information or evidence was received at VA. 38 U.S.C. § 101 (30); 38 C.F.R. § 3.1 (r). 1. Entitlement to an effective date earlier than July 29, 2014 for the award of service connection for tinnitus. The Veteran contends that an effective date earlier than July 29, 2014 is warranted for the grant of service connection for tinnitus. In November 2011, the Veteran filed a claim for service connection for four distinct disabilities: tinnitus, neck injury residuals, bilateral hearing loss, and spine injury residuals. In an August 2012 VA examination, the examiner diagnosed recurrent tinnitus, but opined that it was less likely than not related to military service. In an August 10, 2012 rating decision, the Veteran was denied service connection due to a lack of evidence showing a link to military service. The Veteran did not appeal the decision or submit new and material evidence within one year from the August 10, 2012 rating decision. As such, the August 2012 rating decision became final. In a July 29, 2014 VA audiological examination, the examiner also noted a diagnosis of recurrent tinnitus. The examiner opined that it was at least as likely as not related to military service. In August 2013, the Veteran filed a claim seeking service connection for TBI. He was afforded a VA TBI examination in July 2017. At that time, the Veteran reported tinnitus for many years, but the examiner found that the Veteran’s reports were not consistent with sequelae of TBI. Subsequently, the Veteran was afforded a VA audiological examination on July 29, 2014. The examiner found that the Veteran’s tinnitus was due to military noise exposure. In an August 2014 rating decision, the RO determined that new and material evidence having been received, the claim was reopened. Further, service connection was granted for tinnitus on the basis of the favorable etiology opinion, and a disability rating of 10 percent was assigned with an effective date of July 29, 2014, the date of the examination. Again, the Veteran is seeking an effective date earlier than July 29, 2014, for the grant of service connection for tinnitus. In correspondence dated in May 2016, the Veteran has offered a proposed effective date of August 14, 2013. In another part of the letter, the Veteran contends that an earlier effective date of November 14, 2011 is warranted. Initially, there is no earlier basis to consider a reconsideration of the prior denial of the service connection claim for tinnitus as the August 2012 rating decision was final as to the issue. Thus, an effective date of the initial claim of November 14, 2011 is not warranted. Moreover, the Board finds that an earlier effective date of August 14, 2013 is not warranted. On August 14, 2013, the Veteran filed a claim for TBI injury and for reconsideration of his cervical spine claim. There is no mention of any claim for tinnitus. Also, at that time, the Veteran’s tinnitus was not established as secondary to the Veteran’s service-connected TBI, and the Board acknowledges that it has never been purported to be related to or established as secondary to his service-connected TBI claim. Specifically, the Veteran has never claimed that his tinnitus was related to his TBI; instead, the Veteran asserted that his hearing impairment was due to in-service noise exposure which is an event separate and distinct from his in-service concussion and resulting TBI. Further, no examiner of record has related his service-connected TBI to any hearing impairment. Additionally, the claim of service connection for tinnitus was considered and granted on a direct basis. As such, given that the Veteran never specifically filed a claim to reopen his tinnitus claim, the only basis upon which to grant the effective date was the date that entitlement arose, which was the date of the July 2014 VA examination. In sum, the Board finds that the proper effective date for the award of service connection for tinnitus is July 29, 2014, the date currently assigned by the RO. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Entitlement to TDIU A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran is service-connected for right upper extremity radiculopathy (dominant), now rated at 40 percent; cervical degenerative disc disease, rated at 10 percent from November 14, 2011 and 20 percent beginning August 2, 2017; left upper extremity radiculopathy, rated at 20 percent; tinnitus, rated as 10 percent; traumatic brain injury, rated at 0 percent; and migraine headaches, rated at 0 percent. The Veteran’s combined rating is 10 percent as of November 14, 2011; 30 percent as of July 11, 2013; 40 percent as of July 29, 2014; and 60 percent as of August 2, 2017. Prior to August 2, 2017, the Veteran has not met the schedular requirements for a TDIU at any point on appeal, therefore entitlement to a TDIU on a schedular basis must be denied. Thus, the remaining question is whether referral for extraschedular consideration for a TDIU is appropriate prior to August 2, 2017. However, in light the award herein, as of August 2, 2017, the Veteran does have a combined rating of 70 percent and meets the schedular criteria for a TDIU. Thus, as of that date, the remaining inquiry is whether is unable to secure or follow a substantially gainful occupation. In buddy statements, dated in February 2012, the Veteran’s mother, neighbor, and friend noted that the Veteran has a hard time painting, extending his arms above his head, and looking above. In a July 2013 private treatment record, the Veteran’s physician noted that the Veteran had a minimal degree of limitation of the left upper extremity in a competitive 8-hour workday. The physician noted that the Veteran had a moderate degree of limitation of the right upper extremity in a competitive 8-hour day. that the Veteran was not capable of performing gainful employment with the symptoms and limitations stemming from his cervical spine impairment. The basis for the conclusion was that the Veteran would have a likely progression of symptoms and limitations as time progresses. In an August 2013 statement, the Veteran reported that his cervical spine disability was stopping him from performing his job as a commercial painter, for which job he had held for 22 years. In an August 2017 VA headaches examination, the examiner opined that the Veteran’s headaches impacted his ability to work as the Veteran reported that in the last year, he missed at least three and a half weeks of work, but not on consecutive days, due to severe headaches. Also, in an August 2017 VA neck and radiculopathy examination, the examiner opined that the Veteran’s cervical spine condition impacted his ability to work. Specifically, the examiner noted that while he at work and spraying pain, it is difficult to pull the trigger on the sprayer with the right hand due to paresthesias and numbness in the hand. In a January 2018 VA TBI examination, the examiner opined that the Veteran’s residual conditions attributable to a traumatic brain injury did not impact his ability to work. Significantly, a January 2018 VA mental disorders examination showed that the Veteran was still employed as a commercial painter and had worked for his current boss for seven years. Here, the Board finds that referral for consideration of a TDIU on an extraschedular basis prior to August 2, 2017 and that a TDIU as of August 2, 2017 is not warranted. In this regard, the evidence shows that the Veteran is still able to perform his duties as a commercial painter. The Veteran stated that he has been employed as a commercial painter for over 20 years and remains gainfully employed. Although the Veteran stated that his cervical spine stopped him from doing his job in 2013, he has remained gainfully employed since that time in the same occupation. Although the Board acknowledges that the Veteran’s cervical spine disorder and radiculopathy may have made employment more difficult, the record as a whole does not establish that his condition prevents him from engaging in employment, which is supported by the fact that he was able to retain employment in the same field. The Board also acknowledges that his headaches may have made employment more difficult, but finds that missing up to three and a half weeks from work does not rise to the level to render him unemployable. The Board also notes the July 2013 private cervical spine impairment questionnaire, but notes that the physician stated that the Veteran had minimal and moderate limitation of his upper extremities, in the context of working a competitive 8-hour day. The examiner did not note that the Veteran had marked (essentially precluded) limitation using his upper extremities. Also, the physician’s opinion spoke to the progression of symptoms as related to unemployability, rather than his current state. Further, the Veteran did not return the VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability provided to him (which gathers relevant and indispensable information regarding a claimant’s disabilities and employment and educational histories) or otherwise provide any additional evidence regarding unemployability other than the lay testimony already addressed. In sum, the evidence does not demonstrate that the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities, or that his employment is marginal in nature, and referral for extraschedular consideration for a TDIU prior to August 2, 2017 and entitlement to a TDIU from August 2, 2017 is not warranted. In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). J.N. MOATS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tiffany N. Hanson, Associate Counsel