Citation Nr: 18155720 Decision Date: 12/06/18 Archive Date: 12/04/18 DOCKET NO. 16-35 810 DATE: December 6, 2018 ORDER A rating in excess of 40 percent for back disability, specifically degenerative joint and disc disease of the lumbar spine with foraminal stenosis (previously evaluated as lumbar strain with intervertebral disc syndrome), is denied. An initial rating of 40 percent, but no higher for right leg sciatica, secondary to service-connected back disability, prior to January 25, 2012, is granted. An rating of 20 percent, but no higher for right leg sciatica, secondary to service-connected back disability, from January 25, 2012, to May 22, 2016, is granted. A rating in excess of 10 percent for right leg sciatica, secondary to service-connected back disability, from May 23, 2016, is denied. A rating in excess of 20 percent for left lower extremity radiculopathy, secondary to service-connected back disability, is denied. A total disability rating based on individual unemployability (TDIU) is granted. REMANDED The issue of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, schizophrenia, and psychosis, is remanded. FINDINGS OF FACT 1. The Veteran’s back disability manifested in, at worst, forward flexion ending at 30 degrees or less or intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; the Veteran does not have a diagnosis of ankylosis of the spine. 2. Prior to January 25, 2012, the Veteran’s right leg sciatica, secondary to service-connected back disability, was manifested by pain, paresthesia, and numbness akin to moderately severe incomplete paralysis of the sciatic nerve. 3. From January 25, 2012, to May 22, 2016, the Veteran’s right leg sciatica, secondary to service-connected back disability, was manifested by pain, paresthesia, and numbness akin to moderate incomplete paralysis of the sciatic nerve. 4. From May 23, 2016, the Veteran’s right leg sciatica, secondary to service-connected back disability, was manifested by pain, paresthesia, and numbness akin to mild incomplete paralysis of the sciatic nerve. 5. Throughout the period on appeal, the Veteran’s left lower extremity radiculopathy, secondary to service-connected back disability, was manifested by pain, paresthesia, and numbness akin to moderate incomplete paralysis of the sciatic nerve. 6. For the entire period on appeal, the Veteran has been precluded from securing or following a substantially gainful occupation due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 40 percent for back disability, specifically degenerative joint and disc disease of the lumbar spine with foraminal stenosis (previously evaluated as lumbar strain with intervertebral disc syndrome), have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5243 (2018). 2. Prior to January 25, 2012, the criteria for an initial rating of 40 percent, but no higher, for right leg sciatica, secondary to service-connected back disability, is granted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 8522 (2018). 3. From January 25, 2012, to May 22, 2016, the criteria for an initial rating of 20 percent, but no higher, for right leg sciatica, secondary to service-connected back disability, is granted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 8522 (2018). 4. From May 23, 2016, the criteria for a rating in excess of 10 for right leg sciatica, secondary to service-connected back disability, is denied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 8522 (2018). 5. The criteria for a rating in excess of 20 percent for left lower extremity radiculopathy, secondary to service-connected back disability, is denied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 8526 (2018). 6. The criteria for a TDIU rating have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.25 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1974 to June 1976. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A Veteran’s entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 40 percent for back disability, specifically degenerative joint and disc disease of the lumbar spine with foraminal stenosis (previously evaluated as lumbar strain with intervertebral disc syndrome). The Veteran’s back disability is currently evaluated at 40 percent disabling under the General Rating Formula for Disease and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Under Diagnostic Code 5237, a 40 percent rating is assigned where there is forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A next-higher 50 percent rating is assigned where there is unfavorable ankylosis of the entire thoracolumbar spine. Id. Note (5) provides that 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. Id. During the period on appeal, the Veteran’s back disability was also rated under Diagnostic Code 5243 for incapacitating episodes due to IVDS, which may be rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Diagnostic Code 5243, a 40 percent rating is appropriate when the IVDS manifests in incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A next-higher 60 percent rating is appropriate when the IVDS manifests in incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. For all evaluations under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note 1. IVDS is evaluated under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. For the entire period on appeal, the Veteran has not had a diagnosis of ankylosis. The Veteran’s treatment records, Social Security Administration (SSA) records, and private medical records do not note a diagnosis of ankylosis. Further, the May 2016 VA examination report explicitly states that the Veteran does not have a diagnosis of ankylosis. The Board notes that the criteria for a higher rating is not predicated on range of motion measurements; a next-higher 50 percent rating is assigned where there is unfavorable ankylosis of the entire thoracolumbar spine, which is defined as fixation of the spine in a particular position. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Here, the May 2016 VA examiner explicitly found that the Veteran did not have ankylosis. These findings are consistent with the Veteran’s treatment records. As such, the competent evidence of record does not support a rating in excess of 40 percent disabling under the General Rating Formula for Diseases and Injuries of the Spine Diagnostic Codes 5237 or 5243. As noted above, Diagnostic Code 5243 may also be evaluated under the Formula for Rating IVDS Based on Incapacitating Episodes. In the September 2011 VA examination, the examiner found that the Veteran had a diagnosis of IVDS with total duration of incapacitating episodes over the past 12 months of at least 2 weeks but less than 4 weeks. In subsequent VA examinations, conducted in January 2012 and May 2016, the examiners found that the Veteran did not have a diagnosis of IVDS. A rating in excess of 40 percent is not appropriate unless the IVDS manifests in incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. These findings are consistent with the Veteran’s treatment records. As such, the competent evidence of record does not support a rating in excess of 40 percent disabling under the Formula for Rating IVDS Based on Incapacitating Episodes Diagnostic Code 5243. Based on the foregoing, the Board finds that the Veteran’s back disability is not manifested by ankylosis nor did it require bed rest prescribed by and treatment by a physician for at least 6 weeks during the past 12 months. Therefore, the Board finds that a disability rating in excess of 40 percent for back disability is not warranted at any time during the period on appeal. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an initial rating excess of 10 percent for right leg sciatica, secondary to service-connected back disability. The Veteran’s right leg sciatica has been rated under Diagnostic Code 8520 and Diagnostic Code 8522. The Board notes that throughout the period on appeal, the Veteran’s right leg sciatica has consistently been found to involve the sciatic nerve. Therefore, the Board will rate his right leg sciatica under the Diagnostic Code specifically addressing the sciatic nerve, Diagnostic Code 8520. Under Diagnostic Code 8520, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is assigned for a moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve with muscular atrophy. A maximum 80 percent is assigned for complete paralysis of the sciatic nerve, which manifests in foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” indicates a degree of impaired function substantially less than the type of picture for “complete paralysis” given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The terms “mild,” “moderate,” “moderately-severe,” and “severe” as used under Diagnostic Code 8520 are not defined in the Schedule. Rather than applying a mechanical formula to determine when symptomatology is “mild” or “moderate” etc., the Board must evaluate all of the evidence to ensure an “equitable and just” decision. 38 C.F.R. § 4.6. Prior to January 25, 2012 In the September 2011 rating decision currently on appeal, the Veteran was granted service connection for right leg sciatica, secondary to service-connected back disability, with a 10 percent initial disability rating under Diagnostic Code 8520. During a September 2011 VA examination, the examiner found that the Veteran had right leg sciatica that was etiologically related to his service-connected back disability. The examiner found that the Veteran’s right leg sciatica manifested in severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and mild numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s right leg sciatica involved the sciatic nerve roots and characterized the severity as moderate. The September 2011 VA examination findings are consistent with the Veteran’s treatment records and his statements. The September 2011 examiner found that the Veteran’s right leg sciatica manifested in severe constant and intermittent pain and severe paresthesias and/or dysesthesias. Although the examiner characterized the right leg sciatica as moderate, it appears to the Board that, resolving all reasonable doubt in the Veteran’s favor, moderately severe would be a more appropriate description of the Veteran’s right leg sciatica symptoms. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Based on the foregoing, the Board finds that the Veteran’s right leg sciatica manifested in moderately severe incomplete paralysis of the sciatic nerve. As no right leg muscle atrophy was noted in the September VA examination or the Veteran’s treatment records, a next-higher 60 percent rating for severe incomplete paralysis of the sciatic nerve with muscular atrophy is not appropriate. Accordingly, the Board finds that a rating of 40 percent, but no higher, is warranted prior to January 25, 2012. From January 25, 2012, to May 22, 2016 During a January 2012 VA examination, the examiner found that the Veteran’s right leg sciatica manifested in moderate constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and no numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s right leg sciatica involved the sciatic nerve roots and characterized the severity as moderate. The January 2012 VA examination findings are consistent with the Veteran’s treatment records and his statements. The January 2012 examiner found that the Veteran’s right leg sciatica manifested in moderate constant and intermittent pain and moderate paresthesias and/or dysesthesias. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that moderate would be a more appropriate description of the Veteran’s right leg sciatica symptoms. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Based on the foregoing, the Board finds that the Veteran’s right leg sciatica manifested in moderate incomplete paralysis of the sciatic nerve. As the January 2012 VA examiner described the Veteran’s symptoms for right leg sciatica as “moderate” or “mild,” and the findings are consistent with the Veteran’s treatment record and statements, the Board finds that a finding that the Veteran’s symptoms were “moderately severe” is not appropriate. Accordingly, the Board finds that a rating of 20 percent, but no higher, is warranted from January 25, 2012, to May 22, 2016. From May 23, 2016 During a May 2016 VA examination, the examiner found that the Veteran’s right leg sciatica manifested in moderate constant pain and moderate numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s right leg sciatica involved the sciatic nerve roots and characterized the severity as mild. The examiner noted that the Veteran had neurologic impairment due to both radiculopathy and a cerebrovascular accident, which made it impossible to determine degree based on each. The Board notes that during the May 2016 VA examination, the examination was limited due to the Veteran’s use of a wheelchair for a cerebrovascular accident. The May 2016 VA examination findings are consistent with the Veteran’s treatment records and his statements. As the May 2016 VA examiner described the Veteran’s symptoms for right leg sciatica as moderate constant pain and numbness, which he characterized as having mild symptomatology overall, and did not find any other symptoms related to right leg sciatica, including paresthesias and/or dysesthesias, the Board finds that the Veteran’s right leg sciatica manifested in mild incomplete paralysis of the sciatic nerve. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for right leg sciatica from May 23, 2016; therefore, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy, secondary to service-connected back disability. The Veteran’s left lower extremity radiculopathy has been rated under Diagnostic Code 8526. The Board notes that prior to May 23, 2016, the Veteran’s left lower extremity radiculopathy had consistently been found to involve the femoral nerve. From May 23, 2016, the Veteran’s left lower extremity radiculopathy has been found to involve the sciatic nerve. Therefore, the Board will rate his left lower extremity radiculopathy under the Diagnostic Code specifically addressing the femoral nerve, Diagnostic Code 8526, prior to May 23, 2016, and the Diagnostic Code specifically addressing sciatica, Diagnostic Code 8520, from May 23, 2016. Under Diagnostic Code 8526, a 10 percent rating is assigned for mild incomplete paralysis of the femoral nerve. A 20 percent rating is assigned for moderate incomplete paralysis of the femoral nerve. A 30 percent rating is assigned for a severe incomplete paralysis of the femoral nerve. A maximum 40 percent is assigned for complete paralysis of the femoral nerve with paralysis of quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8526. Under Diagnostic Code 8520, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is assigned for a moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve with muscular atrophy. A maximum 80 percent is assigned for complete paralysis of the sciatic nerve, which manifests in foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” indicates a degree of impaired function substantially less than the type of picture for “complete paralysis” given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The terms “mild,” “moderate,” “moderately-severe,” and “severe” as used under Diagnostic Codes 8520 and 8526 are not defined in the Schedule. Rather than applying a mechanical formula to determine when symptomatology is “mild” or “moderate” etc., the Board must evaluate all of the evidence to ensure an “equitable and just” decision. 38 C.F.R. § 4.6. During a September 2011 VA examination, the examiner found that the Veteran had left lower extremity radiculopathy that was etiologically related to his service-connected back disability. The examiner found that the Veteran’s left lower extremity radiculopathy manifested in no constant pain, no intermittent pain, mild paresthesias and/or dysesthesias, and severe numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s left lower extremity radiculopathy involved the femoral nerve roots and characterized the severity as moderate. During a January 2012 VA examination, the examiner found that the Veteran’s left lower extremity radiculopathy manifested in moderate constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s left lower extremity radiculopathy involved the femoral nerve roots and characterized the severity as moderate. During a May 2016 VA examination, the examiner found that the Veteran’s left lower extremity radiculopathy manifested in moderate constant pain and moderate numbness. The examiner found that there were no other signs or symptoms of radiculopathy, including no muscle atrophy. The examiner also found that the Veteran’s left lower extremity radiculopathy involved the sciatic nerve roots and characterized the severity as mild. The examiner noted that the Veteran had neurologic impairment due to both radiculopathy and a cerebrovascular accident, which made it impossible to determine degree based on each. The Board notes that during the May 2016 VA examination, the examination was limited due to the Veteran’s use of a wheelchair for a cerebrovascular accident. The September 2011, January 2012, and May 2016 VA examination findings are consistent with the Veteran’s treatment records and his statements. In the September 2011, January 2012, and May 2016 VA examinations, all of the symptoms related to the Veteran’s left lower extremity radiculopathy were consistently characterized as “moderate.” These findings are consistent with the Veteran’s treatment records and his statements. As such, the Board finds that the Veteran’s left lower extremity radiculopathy manifested in moderate incomplete paralysis of the femoral or sciatic nerve. Whether the Veteran is being assessed for left lower extremity radiculopathy related to the femoral nerve or the sciatic nerve, moderate incomplete paralysis is assigned a 20 percent rating. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for left lower extremity radiculopathy; therefore, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to TDIU. VA regulations provide that total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to permanently render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 4.15. A total disability rating may be assigned where the schedular rating is less than total when the disabled claimant is unable to secure or maintain substantially gainful employment by reason of one or more service-connected disabilities. 38 C.F.R. § 4.16(a). In order for claimants who have one service-connected disability to qualify for TDIU under section 4.16(a), that disability must be rated 60 percent or greater. Id. In order for claimants who have two or more service-connected disabilities to qualify for a total disability rating, one of the disabilities must be rated 40 percent or greater, and the combined disability rating of all the claimant’s disabilities must be 70 percent or greater. Id. For the purpose of determining whether the Veteran’s disability ratings constitute a single disability rated 60 percent or multiple disabilities one of which is rated 40 percent or greater, certain disabilities can be combined if, among other possibilities, the disabilities result from common etiology or a single accident. Id. It is VA’s policy that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). Rating boards should refer to the Director, Compensation Service for extra-schedular consideration all cases of Veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements set forth in 38 C.F.R. § 4.16(a). A veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. Id. By itself, the fact that a veteran is unemployed or has difficulty obtaining employment is not enough to establish entitlement to TDIU. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). “The question is whether the veteran is capable of performing the physical and mental acts required by employment.” Id. The issue of entitlement to TDIU was first raised by the record in conjunction with the issue of an increased rating for all of the Veteran’s service-connected disabilities. Rice v. Shinseki, 22 Vet. App 447 (2009). As an initial matter, the Board finds that the Veteran has met the schedular requirement for TDIU throughout the period on appeal. Pursuant to this decision, prior to January 25, 2012, the Veteran has been assigned a 40 percent rating for back disability, a 40 percent rating for right leg sciatica, and a 20 percent rating for left lower extremity radiculopathy. The Veteran’s combined disability rating was 70 percent. From January 25, 2012, to May 22, 2016, the Veteran has been assigned a 40 percent rating for back disability, a 20 percent rating for right leg sciatica, and a 20 percent rating for left lower extremity radiculopathy. The Veteran’s combined disability rating was 60 percent. From May 22, 2016, the Veteran has been assigned a 40 percent rating for back disability, a 10 percent rating for right leg sciatica, and a 20 percent rating for left lower extremity radiculopathy. The Veteran’s combined disability rating is 60 percent. See 38 C.F.R. § 4.16(a), 4.25. The Veteran’s right leg sciatica and left lower extremity radiculopathy are secondary to his service-connected back disability and therefore are considered one disability because they have a common etiology. 38 C.F.R. § 4.16(a). As such, the Board finds that the Veteran met the schedular requirement of one service-connected disability rated at 60 percent or more. Id. The record indicates that the Veteran has not been employed for several years. The symptomatology of the Veteran’s service-connected disabilities were detailed in the September 2011, January 2012, and May 2016 VA examinations. Throughout the period on appeal, the record indicates that the Veteran was limited in his ability to walk. Specifically, the record indicates that he could walk, at most, about 100 yards on a good day. The record also indicates that throughout the period on appeal, his service-connected disabilities impaired his ability to stand or participate in activities that require lifting more than 25 pounds or to move his back without pain or excess fatigability. In the September 2011 and January 2012 VA examinations, the examiners found that the Veteran’s service-connected disabilities interfered with his ability to sit. These finding are consistent with the Veteran’s October 2015 statement (which was received in November 2015), indicating that he has been unable to bend, stoop, kneel, stand, sit, or walk for extended periods of time since February 2001 due to his back and leg pain. Further, throughout the period on appeal, the Veteran has consistently used a cane or a wheelchair as an assistive device. The Board notes that the wheelchair is used for a non-service connected a cerebrovascular accident; however, there is no indication that the Veteran would not still be using a cane if he did not have the cerebrovascular accident. The record indicates that the Veteran’s education consists of a General Education Diploma (GED) and a commercial truck driver license. In a private assessment submitted in December 2016 (dated October 2016), the rehabilitation counselor indicated that the Veteran does not have computer skills. Given the Veteran’s educational background, he would reasonably be expected to perform more physically demanding jobs or a job like a truck driver. However, as his service-connected disabilities prevent him from lifting more than 25 pounds and from walking, standing, or sitting for extended periods of time, the Veteran would be precluded from securing or following a physically demanding job or a job like a truck driver. Therefore, the Board finds that the Veteran is precluded from securing or following a substantially gainful occupation due to his service-connected disabilities for the entire period on appeal. Generally, the effective date for an increased rating, including TDIU, is the date of receipt of the claim or date entitlement arose, whichever is later. If, however, the claim is filed within one year of the date that the evidence shows that an increase in disability has occurred, the effective date is the earliest date as of which an increase is factually ascertainable. 38 U.S.C. § 5110 (b)(3) (2012); 38 C.F.R. § 3.400(o) (2015). See also Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010). The record does not include a factually ascertainable date within one year prior to the June 2011 claim (for increased ratings for his service connected disabilities) for when the Veteran’s service-connected disabilities increased in severity to preclude securing or following a substantially gainful occupation. Accordingly, the Board finds that the Veteran is granted TDIU for the entire period on appeal. REASONS FOR REMAND The issue of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), schizophrenia, and psychosis, is remanded. The Veteran submits that he has PTSD related to an incident while in service. The Veteran’s claim has been recharacterized to encompass any acquired psychiatric disorder diagnosis. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran’s claim for PTSD has been denied for a lack of a diagnosis and a lack of a verified in-service stressor. The record indicates that the Veteran has had mental health diagnoses of schizophrenia and psychosis. Further, the July 1974 induction Report of Medical Examination noted that the Veteran had a psychiatric defect or diagnosis of acute situational reaction. Based on the foregoing, the Board finds that the Veteran should be afforded a VA examination to determine whether he has an acquired psychiatric disorder that is etiologically related to or aggravated by service. The matter is REMANDED for the following action: Schedule the Veteran for an appropriate examination by a VA clinician to determine the nature and etiology of his alleged psychiatric disorder(s). Based on the examination results and a review of the record, the examiner should provide an opinion as to whether the Veteran has any psychiatric disorders. For each psychiatric disorder diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that each psychiatric disorder is etiologically related to active service. A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Shah, Nirali