Citation Nr: 18155776 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 15-35 439A DATE: December 6, 2018 ORDER Entitlement to service connection for a left arm disability is denied. Entitlement to service connection for a right arm disability is denied. Entitlement to service connection for a left leg disability is denied. Entitlement to service connection for a right leg disability is denied. Entitlement to service connection for a neck disability is denied. Entitlement to service connection for epilepsy, diencephalic is denied. Entitlement to service connection for a headache disability is granted. Entitlement to a rating in excess of 30 percent for degenerative joint disease of the left hip is denied. Entitlement to a rating in excess of 10 percent for left knee chondromalacia patella prior to October 8, 2018, and as 20 percent thereafter is denied. Entitlement to a rating in excess of 40 percent for lumbar strain with L5-S1 nerve root compression is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity peripheral neuropathy prior to October 8, 2018, and as 20 percent thereafter is denied. Entitlement to an effective date prior to January 30, 2014, for the grant of service connection for left lower extremity peripheral neuropathy is denied. FINDINGS OF FACT 1. The Veteran does not have a currently diagnosed left arm disability. 2. The Veteran does not have a currently diagnosed right arm disability. 3. The Veteran does not have a currently diagnosed left leg disability. 4. The Veteran does not have a currently diagnosed right leg disability. 5. The Veteran’s neck disability did not originate in service or until more than a year following service, and is not otherwise etiologically related to service. 6. The Veteran’s epilepsy, diencephalic did not originate in service or until more than a year following service, and is not otherwise etiologically related to service. 7. The Veteran’s headache disability is caused by service-connected disabilities. 8. The Veteran’s left hip disability was not manifested by fracture of the surgical neck of the femur with false joint or fracture of the shaft or anatomical neck of the femur with nonunion. 9. Prior to October 8, 2018, the Veteran’s left knee was manifested by range of motion from 0 to 60 degrees; there was no evidence of recurrent subluxation or lateral instability and no locking or effusion in the left knee; semilunar cartilage has not been removed from his right knee; and ankylosis has not ben shown in the Veteran’s left knee. 10. Since October 8, 2018, the Veteran’s left knee was manifested by range of motion from 0 to 25 degrees; there was no evidence of locking or effusion in the left knee; semilunar cartilage has not been removed from his left knee; and ankylosis has not ben shown in the Veteran’s left knee. 11. The Veteran’s lumbar spine disability has not been manifested by unfavorable ankylosis of the entire thoracolumbar spine at any time during the appeal period at issue. 12. Prior to October 8, 2018, the Veteran’s left lower extremity peripheral neuropathy was manifested by no more than mild sensory deficit. 13. Since October 8, 2018, the Veteran’s left lower extremity peripheral neuropathy was manifested by no more than moderate incomplete paralysis of the sciatic nerve. 14. On January 30, 2014, the Veteran submitted a claim for an increased disability rating for his service-connected lumbar spine disability. While developing this claim, the RO determined that the Veteran was entitled to service connection for peripheral neuropathy of the left lower extremity secondary to his service- connected lumbar spine disability; no further communication from the Veteran or any representative seeking service connection for peripheral neuropathy of the extremities was received prior to January 30, 2014. CONCLUSIONS OF LAW 1. The criteria for service connection for a left arm disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 2. The criteria for service connection for a right arm disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 3. The criteria for service connection for a left leg disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 4. The criteria for service connection for a right leg disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 5. The criteria for service connection for a neck disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). 6. The criteria for service connection for epilepsy, diencephalic have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). 7. The criteria for secondary service connection for headaches are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 8. The criteria for a disability rating in excess of 30 percent for degenerative joint disease of the left hip have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5255 (2018). 9. Prior to October 8, 2018, the criteria for a rating in excess of 10 percent for chondromalacia of the left knee have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.7, 4.71, 4.71a, Diagnostic Codes 5257, 5260, 5261 (2018). 10. Since October 8, 2018, the criteria for a rating in excess of 20 percent for chondromalacia of the left knee have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.7, 4.71, 4.71a, Diagnostic Codes 5257, 5260, 5261 (2018). 11. The criteria for a rating in excess of 40 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243 (2018). 12. Prior to October 8, 2018, the criteria for a rating in excess of 10 percent for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.123, 4.124a, Diagnostic Code 8520 (2018). 13. Since October 8, 2018, the criteria for a rating in excess of 20 percent for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.123, 4.124a, Diagnostic Code 8520 (2018). 14. The criteria for an effective date earlier than January 30, 2014, for the grant of service connection for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.114, 3.151, 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1984 to July 1990. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions of a Regional Office (RO) of the Department of Veterans’ Affairs (VA). The Veteran’s claims were remanded for additional development in December 2017. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900 (c) (2018). 38 U.S.C. § 7107(a)(2) (2012). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304. Establishing service connection requires evidence of (1) a current disability; (2) an 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 disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be granted for certain chronic diseases, including epilepsies, when such disability is manifested to a degree of 10 percent or more within one year of discharge from service. See 38 U.S.C. §§ 1101, 1133; 38 C.F.R. §§ 3.307, 3.309. When chronic diseases are at issue, the second and third elements for service connection may alternatively be established by showing continuity of symptomatology. See Walker v. Shinseki, 701 F.3d 1331 (Fed. Cir. 2013). Left Upper Arm, Right Arm, Left Leg, and Right Leg The Veteran contends that he has arm and leg conditions that are related to his active service. See VA Form 21-526, Veteran’s Application for Compensation and/or Pension, received in March 2014. A review of the Veteran’s service treatment reports reflects that he had a normal clinical evaluation of the upper and lower extremities at his February 1984 entrance examination and June 1990 separation examination. The records do not reflect any complaints, findings, or treatment for the arms or legs. Post-service treatment reports from various providers including Vidant Medical Center and Halifax Regional Medical Center do not reflect any complaints, findings, or treatment for the arms or legs. VA outpatient treatment reports reflect reports of weakness in the right arm and leg in July 2013 and pain in the left leg and right arm in July 2015. No diagnoses or functional impairments were associated with the leg and arm symptoms reported. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). In this case, the evidence of record does not contain probative evidence of a disability of the left arm, right arm, left leg, or right leg at any time proximate to, or during, the appeal period. The VA and private treatment records associated with the claims file do not contain a diagnosis of any disability of the arms or legs. The Veteran has not submitted any lay statements which specify the claimed disabilities or any functional impairment caused by the claimed bilateral arm and leg disabilities. Thus, the most probative evidence fails to demonstrate that it is at least as likely as not that the Veteran has current disabilities of the bilateral arms and legs that had their onset during active service or that there are current disabilities of the bilateral arms and legs that are otherwise causally or etiologically related to his active service. As such, service connection for disabilities of the bilateral arms and legs is not warranted. Degmetich, 104 F. 3d at 1333. The Board acknowledges that the Veteran was not afforded a VA examination relating directly to his claimed bilateral arm and leg disabilities. On these facts, however, an examination is not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d) (2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the claim does not meet these requirements for obtaining a VA medical opinion. Because the weight of the evidence demonstrates no indication of current disabilities, no examinations are required. Absent evidence that indicates that the Veteran has the currently claimed disabilities that are related to an injury or symptoms in service, the Board finds that a VA examination or opinion is not necessary for disposition of the claims. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion with respect to the Veteran’s claims for entitlement to service connection for the bilateral arms and legs have been met. 38 C.F.R. § 3.159(c)(4). As noted above, the threshold requirement for service connection is competent medical evidence of the existence of the claimed disability at some point during the course of the appeal or in proximity to the claim. See Degmetich, 104 F. 3d at 1332; see also McClain v. Nicholson, 21 Vet. App. 319 (2013). The Board is cognizant of the holding in Saunders v. Wilkie which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). In sum, pain alone resulting in functional impairment is in fact a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Veteran does not claim, nor do his medical records show that he experiences any functional impairment due to the pain noted at VA. As such, the record does not reflect that the Veteran has reported pain that amounts to a functional impairment of earning capacity, and Saunders is not applicable in this case. In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case there is an absence of proof of a bilateral arm or leg disability during the appeal period. Without evidence of a current diagnosis of bilateral leg and arm disabilities, the Board need not address the other elements of service connection. Accordingly, the Board finds that the preponderance of the evidence is against the claims for service connection for bilateral arm and leg disabilities. The benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Neck Disability and Epilepsy The Veteran contends that he has a neck condition and epilepsy that are related to his active service. See VA Form 21-526, Veteran’s Application for Compensation and/or Pension, received in March 2014. A review of the Veteran’s service treatment reports reveals that the Veteran had a normal clinical evaluation of the head and neck and neurologic system at his February 1984 entrance examination and June 1990 separation examination. The records do not reflect any complaints, findings, or treatment for a neck disability or epilepsy. Post-service VA treatment reports reveal that the Veteran was first treated for partial complex seizure at VA in March 2012. A June 2013 magnetic resonance imaging (MRI) of the cervical spine revealed cervical stenosis and degenerative joint disease. The Veteran was assessed with epilepsy in July 2013. Post-service private treatment reports from Vidant Medical Center reflect a diagnosis of degenerative disc disease of the cervical spine and spinal stenosis in May 2013. He was noted to have a past medical history of epilepsy. Having reviewed the complete record, the Board finds that the evidence does not establish that service connection is not warranted for the Veteran’s neck disability or epilepsy. As an initial matter, there is no evidence of a diagnosis of arthritis of the cervical spine or epilepsy within one year of the Veteran’s separation from service to allow for service connection on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309(a). Unfortunately, there is also no competent evidence that suggests that any current neck disability or epilepsy either began during or were otherwise caused by the Veteran’s active service. The Veteran’s service treatment reports do not reflect any complaints, findings, or treatment for the neck or epilepsy. Post-service treatment reports reflect a diagnosis of stenosis of the cervical spine and degenerative joint/disc disease in 2013 and epilepsy in 2012, more than twenty years after the Veteran separated from service. The Veteran has not submitted any medical evidence linking any current neck disability or epilepsy to his active service. Hence, the Board finds that the competent evidence of record does not reveal a showing of a relationship between the Veteran’s claimed neck disability or epilepsy and his period of service. With the exception of the claims submitted, the Veteran has not submitted any lay evidence suggesting that his claimed neck disability or epilepsy is related to service. As noted, the Veteran has submitted no competent medical evidence or opinions to corroborate the contention that his claimed neck disability or epilepsy is related to his active service. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran’s opinion is not competent to provide the requisite etiology of a current neck disability or epilepsy, because such a determination requires medical expertise. As a lay person, the Veteran is considered competent to report what comes to him through his senses, but he lacks the medical training and expertise to provide a medical opinion as to the etiology of the claimed neck disability and epilepsy. See Layno v. Brown, 6 Vet. App. 465 (Fed. Cir. 2007). The Veteran’s opinion on its own is insufficient to provide the requisite nexus between a neck disability or epilepsy and his active service. Therefore, the lay statements regarding the Veteran’s claimed neck disability and epilepsy being related to service are not considered to be competent nexus evidence, as the Veteran is not medically qualified to provide evidence regarding matters requiring medical expertise, such as an opinion as to etiology. With regard to the claims for entitlement to service connection for a neck disability and epilepsy, while a VA medical opinion was not provided, the Federal Circuit Court of Appeals (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A(d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). There is no suggestion that either a neck disability or epilepsy began during service or within one year of service. As such, VA’s duty to provide an examination with an opinion is not triggered. See Waters, 601 F.3d 1274. Accordingly, the Board finds that the preponderance of the evidence is against the claims for service connection for a neck disability and epilepsy. The benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Headache The Veteran claimed entitlement to service connection for headaches. See VA Form 21-526, Veteran’s Application for Compensation and/or Pension, received in March 2014. Service connection may also be granted on a secondary basis when a disability which is proximately due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another condition. The Veteran’s service treatment reports reflect that he sustained a right eye injury in May 1989 and was thereafter assessed with post-traumatic headaches. Neurologic examination was normal at the Veteran’s June 1990 separation examination. The Veteran is service-connected for unspecified depressive disorder, tinnitus, hypertension, and strokes associated with hypertension, among other disabilities. A private examiner, M. Blevins, M.D., rendered a diagnosis of tension headaches in January 2017. See January 2017 headache disability benefits questionnaire (DBQ). Dr. Blevins reviewed the claims file and conducted an interview of the Veteran over the phone. Dr. Blevins opined that that the Veteran’s headaches were caused by his service-connected tinnitus, hypertension, and depressive disorder with anxiety. Dr. Blevins noted that the headaches had multifactorial causes including service-connected hypertension, depressive disorder with anxiety, tinnitus, and a history of stroke. Dr. Blevins provided a rationale, included several medical articles with the opinion, and cited to the medical treatise evidence. A VA examiner rendered a diagnosis of post-traumatic headaches at a VA examination in October 2018. The examiner also indicated that the Veteran had trigeminal neuralgia and opined that it was less likely than not that the claimed headache disability was proximately due to or the result of a service-connected disability. The examiner’s rationale was that the she was unable to confirm a chronic diagnosis based on the records available and examination conducted. The Board finds the preponderance of the evidence supports the Veteran’s headaches are secondary to his service-connected tinnitus, hypertension, and depressive disorder with anxiety. The Board gives great probative weight to the January 2017 private opinion that the Veteran’s headaches are caused by his service-connected tinnitus, hypertension, and depressive disorder with anxiety. The Board finds the opinion credible because the examiner considered the claims file and cited to medical articles to support her opinion. The VA examiner did not consider the private medical opinion or cite to any medical treatise evidence nor did she explain why she rendered diagnoses related to the claimed headache disorder but ultimately concluded that the Veteran does not have a current disability. Affording the Veteran the benefit-of-the-doubt, the Board concludes that service connection for headaches is warranted. Increased Rating 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). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Court of Appeals for Veterans Claims (Court) has held that the final sentence of § 4.59 creates a requirement that certain range of motion and other testing be conducted whenever possible in cases of joint disabilities. Correia v. McDonald, 28 Vet. App. 158 (2016). Left Hip The Veteran contends that his left hip disability warrants a rating in excess of 30 percent. The Veteran was afforded a VA examination in September 2014. He reported pain and reduced range of motion. Range of motion testing of the right (nonservice-connected) hip revealed flexion to 65 degrees, with no objective evidence of painful motion, extension was greater than 5 degrees with no objective evidence of pain, abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran could not cross his legs, and rotation was not limited such that the Veteran could not toe-out more than 15 degrees. Range of motion testing of the left hip revealed flexion to 50 degrees with no objective evidence of painful motion, extension was greater than 5 degrees with no objective evidence of pain, abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran could not cross his legs, and rotation was not limited such that the Veteran could not toe-out more than 15 degrees. The Veteran was able to perform repetitive use testing with three repetitions with no additional limitation of the hip or thigh with repetitive use testing. However, the examiner indicated that the Veteran had less movement than normal bilaterally and pain on movement of the left hip and thigh. There was no ankylosis of either hip. The examiner also included additional range of motion for the right and left hip which revealed adduction of the right hip to 35 degrees with no pain and adduction of the left hip to 40 degrees with pain at 40 degrees, abduction of the right hip to 30 degrees with no pain and abduction of the left hip to 25 degrees with pain at 25 degrees, external rotation of the right hip with no pain and external rotation of the left hip to 20 degrees with pain at 20 degrees, and internal rotation of the right hip to 40 degrees with no pain and internal rotation of the left hip with pain at 20 degrees. The examiner was unable to state any additional limitations due to flare-ups or with repeated use of the joint without resort to speculation. At a VA examination in October 2018, the Veteran reported daily pain, stiffness, and swelling of the left hip. He indicated that he was unable to jump, and difficulty running, hiking, lifting, bending, and standing for long periods. He endorsed flare-ups one to two times per month when he notices discoloration and swelling of the hip. Range of motion testing of the right (nonservice-connected) hip revealed flexion to 115 degrees, extension to 15 degrees, abduction to 20 degrees, adduction to 25 degrees, external rotation to 35 degrees, and internal rotation to 20 degrees with no pain noted on examination. Range of motion testing of the left hip revealed flexion to 125 degrees, extension to 25 degrees, abduction to 10 degrees, adduction to 10 degrees, external rotation to 15 degrees, and internal rotation to 5 degrees with pain noted in all ranges of motion and objective evidence of pain on weight-bearing and localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran had no additional loss of motion after three repetitions of the right hip and he would not perform three repetitions of motion of the left hip due to fear of pain. The examiner indicated that she was unable to say whether there was any additional loss of function with flare-ups without resort to speculation. There was no ankylosis of either hip, no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The Veteran ambulated with a cane for stability and pain. The Veteran’s degenerative joint disease of the left hip has been rated as 30 percent disabling pursuant to Diagnostic Code 5255. 38 C.F.R. § 4.71a, Diagnostic Code 5255. Diagnostic Code 5255 provides that a 30 percent rating will be assigned for malunion of the femur with marked knee or hip disability; a 60 percent rating will be assigned for impairment of femur with nonunion, without loose motion, weight bearing preserved with aid of brace, or for fracture of surgical neck of the femur with false joint; and an 80 percent rating will be assigned for impairment of femur, fracture shaft or anatomical neck, with nonunion, with loose motion (spiral or oblique fracture). 38 C.F.R. § 4.71a, Diagnostic Code 5255. Having reviewed the claims file and the evidence listed above, the Board has determined that the Veteran's left hip disability does not warrant a rating in excess of 30 percent at any time during the time period on appeal. The evidence as reported above does not reflect that that Veteran’s left hip disability is manifested by impairment of femur with nonunion, without loose motion, weight bearing preserved with aid of brace, or for fracture of surgical neck of the femur with false joint at any time during the period on appeal. The Board also considered whether the Veteran's left hip disability warrants an increased rating under any other Diagnostic Codes pertaining to the hip, including Diagnostic Codes 5250 through 5254. 38 C.F.R. § 4.71a. The Board finds that Diagnostic Codes 5250 for ankylosis of the hip and 5254 for flail joint of the hip are not applicable because the evidence does not show that the Veteran's left hip disability was manifested by ankylosis or flail joint during the appeal period. In addition, the Board has considered Diagnostic Codes 5251, 5252, and 5253 for limitation of motion. While separate disability ratings may be assigned for distinct disabilities resulting from the same injury, this may only be done so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259 (1994). Although examinations showed some limited motion, assignment of a separate, compensable rating for the left femur under Diagnostic Codes 5251 or 5253 would constitute impermissible pyramiding as the symptomology is duplicative or overlapping with the assigned rating under Diagnostic Code 5255. In this regard, Diagnostic Code 5255 is broad in scope, and the factors of pain with limitation in motion and function are addressed by the Veteran's current rating. In addition, the Veteran's left hip disability was not manifested by flexion limited to 10 degrees, which would warrant a 40 percent rating under Diagnostic Code 5252. The VA examinations showed left flexion limited to no less than 50 degrees, and the Veteran has not described limitation to 10 degrees. Thus, ratings pursuant to limitation of motion would not provide the Veteran with a more beneficial rating. In sum, a rating in excess of 30 percent is not warranted at any time during the pendency of the appeal. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Left Knee The Veteran contends that his left knee disability warrants rating in excess of 10 percent for left knee chondromalacia patella prior to October 8, 2018, and as 20 percent thereafter. As an initial matter, the Board notes that the Veteran was granted service connection for instability of the left knee effective October 8, 2018. The Veteran has not expressed disagreement with the rating or effective date assigned. As such, the Board will not address that issue. At a September 2014 VA examination, the Veteran reported knee pain and flare-ups with swelling. He also indicated that he had reduced endurance for walking in winter or damp weather. Range of motion testing revealed flexion to 60 degrees with pain, extension to 0 degrees with no objective evidence of painful motion, and no changes in the ranges of motion after three repetitions of motion. Range of motion testing of the right (nonservice-connected) knee revealed 95 degrees of flexion and 0 degrees of extension and no changes in the ranges of motion after three repetitions. The examiner noted that the Veteran had less movement than normal and pain on movement bilaterally. There was no tenderness or pain to palpation for joint line or soft tissues of either knee. Muscle strength testing and joint stability testing was normal bilaterally. There was no evidence or history of recurrent subluxation/dislocation. The Veteran did not have a meniscal condition or any surgical procedures. The Veteran ambulated with a cane for the low back, left hip, left thigh, and left knee pain and weakness. X-rays of the left knee did not reveal degenerative arthritis or patellar subluxation. The examiner indicated that he was unable to state whether there was any additional functional loss during flare-ups without resort to speculation. At a VA examination in October 2018, the Veteran reported pain with long distance walking and standing, occasional swelling, and occasional locking. The Veteran denied flare-ups of the knee. The Veteran indicated that he was unable to bowl, play sports, or enjoy time with his grandchildren due to pain and limitation of movement. Range of motion testing of the left knee revealed flexion to 25 degrees and extension to 0 degrees with pain. There was evidence of pain with weight-bearing but no objective evidence of crepitus. The Veteran had guarding with movement which caused stiffness. There was pain with touching the entire patella. Range of motion testing of the right (nonservice-connected) knee revealed flexion to 85 degrees and extension to 0 with pain. There was evidence of pain with weight-bearing and objective evidence of crepitus. The Veteran was unable to perform repetitive use testing of the left leg due to fear of pain. The examiner was unable to state whether there was any additional loss of function due to pain, weakness, fatigability, or incoordination without resort to speculation. There was no history of recurrent subluxation. There was slight lateral instability of the left knee and recurrent effusion manifested by repeated swelling. There was no ankylosis of the knees. The examiner noted that there was objective evidence of pain on passive range of motion testing, objective evidence of pain in non-weight bearing, and evidence of pain damage of the opposing joint as noted. X-rays of the left knee did not reveal arthritis. Prior to October 8, 2018 For the period prior to October 8, 2018, the Veteran’s left knee disability was rated as 10 percent pursuant to Diagnostic Code 5260. 38 C.F.R. § 4.71a. The Board will address whether a higher rating is warranted under any of the Diagnostic Codes relating to rating knee disabilities from Diagnostic Code 5256 through 5263. 38 C.F.R. § 4.71a. Diagnostic Code 5257 pertains to other impairment of the knee caused by recurrent subluxation or lateral instability. A 10 percent rating is warranted when slight. A 20 percent rating is warranted when moderate. A 30 percent rating is warranted when severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The evidence of record does not establish that the Veteran's left knee disability was manifested by recurrent subluxation at any time during the relevant time period. With regard to lateral instability, the relevant examination of record revealed no instability on examination in 2014. Consequently, there is no evidence of lateral instability at any time during the relevant time period. Diagnostic Code 5261 pertains to limitation of extension. Limitation of extension of the leg to 5 degrees warrants a 0 percent rating; a 10 percent rating requires that extension be limited to 10 degrees; a 20 percent rating requires that extension be limited to 15 degrees; a 30 percent rating requires that extension is limited to 20 degrees; a 40 percent rating requires that extension be limited to 30 degrees; and a 50 percent rating requires that extension be limited to 45 degrees or more. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In this case, the Board finds that the evidence of record does not reflect evidence of any limitation of extension during the relevant appeal period. The Veteran had extension of 0 degrees at the VA examination in 2014, which does not warrant a compensable rating under Diagnostic Code 5261 for the left knee. Consequently, the Board finds that the Veteran's left knee disability does not warrant any higher rating for limitation of extension. Diagnostic Code 5260 pertains to limitation of flexion. Flexion limited to 60 degrees warrants a 0 percent rating; flexion limited to 45 degrees warrants a 10 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. In this case, there is evidence of some limitation of motion in flexion. However, flexion was limited to no less than 60 degrees during the relevant appeal period at issue, which does not warrant a compensable rating under Diagnostic Code 5260 for the left knee. Consequently, an increased rating is not warranted under Diagnostic Code 5260. The Board has considered the Veteran's complaints of pain causing functional loss in determining the rating, but finds that any additional loss caused by pain or other factors does not cause the disability to warrant a rating higher than the 10 percent rating already assigned for the left knee disability. 38 C.F.R. §§ 4.40, 4.45. The VA examiner in 2014 considered the point at which there was pain on range of motion and also reported whether there was additional pain with repetition of motion. The examiner noted that there were no additional limitations following three repetitions of motion. Diagnostic Codes 5256 (ankylosis of the knee), 5258 (dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint), 5259 (removal of symptomatic semilunar cartilage), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum) are not applicable because the Veteran's left knee disability is not manifested by any of the disabilities or symptoms associated with those diagnostic codes during the relevant time period at issue. 38 C.F.R. § 4.71a. In sum, the Veteran's left knee disability does not warrant a higher rating under any of the Diagnostic Codes pertaining to disabilities of the knee prior to October 8, 2018. Since October 8, 2018 As noted, the Veteran's disability rating was increased to 20 percent effective October 8, 2018, the date of his most recent VA examination, pursuant to Diagnostic Code 5260. 38 C.F.R. § 4.71a. Additionally, as noted, the Veteran was granted a separate 10 percent rating of instability of the left knee which is not the subject of this appeal. The Board will now address whether a higher rating is warranted under any of the Diagnostic Codes relating to rating knee disabilities from Diagnostic Code 5256 through 5263. 38 C.F.R. § 4.71a. Diagnostic Code 5257 pertains to other impairment of the knee caused by recurrent subluxation or lateral instability. As noted, a separate rating was granted pursuant to this diagnostic code and the Veteran has not appealed the rating or effective date assigned and the Board will therefore not address this issue. Diagnostic Code 5261 pertains to limitation of extension. In order to obtain a rating in excess of 20 percent, there must be evidence of extension limited to at least 20 degrees. 38 C.F.R. § 4.71a. In this case, the Board finds that the evidence of record does not reflect evidence of any limitation of extension during the relevant appeal period. As such, a higher rating is not warranted under this diagnostic code. Diagnostic Code 5260 pertains to limitation of flexion. In order to obtain a rating in excess of 20 percent, there must be evidence of flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. In this case, at the October 2018 VA examination, flexion was limited to 25 degrees. This finding is tantamount to the currently assigned 20 percent rating under Diagnostic Code 5260 for the left knee. Consequently, an increased rating is not warranted under Diagnostic Code 5260. The Board has considered the Veteran's complaints of pain causing functional loss in determining the rating, but finds that any additional loss caused by pain or other factors does not cause the disability to warrant a rating higher than the 20 percent rating already assigned for the left knee disability. 38 C.F.R. §§ 4.40, 4.45. The VA examiner in 2018 considered the point at which there was pain on range of motion. The examiner was unable to state whether there was any additional functional loss with repeated use over a period of time. Diagnostic Codes 5256 (ankylosis of the knee), 5258 (dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint), 5259 (removal of symptomatic semilunar cartilage), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum) are not applicable because the Veteran's left knee disability is not manifested by any of the disabilities or symptoms associated with those diagnostic codes during the relevant time period at issue. 38 C.F.R. § 4.71a. In sum, the Veteran's left knee disability does not warrant a rating in excess of 20 percent under any of the Diagnostic Codes pertaining to disabilities of the knee since October 8, 2018. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Lumbar Spine The Veteran contends that a rating in excess of 40 percent is warranted for his service-connected lumbar spine disability. At a VA examination in September 2014, the Veteran reported pain and stiffness in the lower back which interfered with sleeping, standing, and sitting. The Veteran endorsed flare-ups which reduced his endurance for walking and sitting. Range of motion testing revealed flexion to 90 degrees, extension to 30 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 25 degrees. The Veteran was able to perform three repetitions of motion with no additional loss of motion. There was not ankylosis of the spine. The examiner indicated that the Veteran’s range of motion may be reduced during flare-ups or repeated use of the joint but it was not possible to express any such limitation in terms of degree of additional loss of range of motion without resort to speculation. At a VA examination in October 2018, the Veteran was assessed with degenerative disc disease of the lumbar spine. The Veteran reported daily pain with tingling of the left leg. The Veteran endorsed flare-ups of the thoracolumbar spine. He indicated that the more he moved around the more pain he had and sitting or lying down decreased pain. He ambulated with a cane. Range of motion testing revealed forward flexion to 20 degrees, extension to 5 degrees, right lateral flexion to 25 degrees, left lateral flexion to 15 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 20 degrees. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the back. The Veteran was unable to perform three repetitions of motion due to being unstable on his feet. He only did one round of testing due to safety. The examiner was unable to state any loss in terms of range of motion during flare-ups without resort to speculation. There was no ankylosis of the spine. The Veteran did not have any episodes of acute signs or symptoms due to intervertebral disc syndrome. Under the General Rating Formula for Disease and Injuries of the Spine, a 40 percent evaluation will be assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation will be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation will be assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. §4.71a, Diagnostic Codes 5235 to 5242. Note (1): Evaluate any associated objective neurologic abnormalities, including but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Id. Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The 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 thoracolumbar spine is 240 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. Id. Note (5): 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. When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable Diagnostic Code, any additional functional loss the Veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80 (1997). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Diagnostic Code 5243 provides that a 40 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4,71a, Diagnostic Code 5243. As an initial matter, the Board notes that the Veteran was granted service connection for peripheral neuropathy of the right lower extremity during the course of the appeal and assigned a 10 percent rating for that disability effective October 8, 2018. He has not expressed disagreement with the rating or effective date assigned. As such, the Board will not address the right lower extremity. The left lower extremity is discussed below. Having reviewed the claims file and the evidence listed above, the Board has determined that the Veteran's lumbar spine disability does not warrant a rating in excess of 40 percent at any time during the time period on appeal. The Veteran's lumbar spine disability was not manifested by incapacitating episodes of intervertebral disc syndrome lasting at least six weeks during a twelve-month period and unfavorable ankylosis of the entire thoracolumbar spine has not been shown at any time during the appeal period at issue. As such, a rating in excess of 40 percent is not warranted at any time. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Left Lower Extremity Peripheral Neuropathy The Veteran contends that the service-connected left lower extremity peripheral neuropathy warrants a rating higher than 10 percent prior to October 8, 2018, and as 20 percent thereafter. At a September 2014 VA examination, muscle strength testing was normal for left hip flexion, left knee extension, left ankle plantar flexion, left ankle dorsiflexion, and left great toe extension. Deep tendon reflexes were normal in the left knee and ankle. Sensory examination revealed that sensation to light touch was normal in the left upper thigh (L2), left thigh/knee (L3/4), left lower leg/ankle (L4/L5/S1), and left foot and toes (L5). Position sense testing was intact and straight leg raising was negative. The examiner assessed the Veteran with mild left lower extremity constant pain, no intermittent pain, mild left lower extremity paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. The examiner diagnosed the Veteran with mild radiculopathy of the left lower extremity. At an October 2018 VA examination, muscle strength testing on the left revealed active movement against some resistance in hip flexion, active movement against some gravity in knee extension, ankle plantar flexion, and ankle dorsiflexion, and active movement with gravity eliminated in great toe extension. There was no muscle atrophy. Deep tendon reflexes were normal in the left knee and ankle. Sensation to light touch was normal in the left upper anterior thigh (L2), thigh/knee (L3/4), lower leg/ankle (L4/L5/S1), and foot/toes (L5). Straight leg raising was positive on the left. The Veteran had signs of left radiculopathy manifested by moderate constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The examiner assessed the Veteran with moderate radiculopathy of the L4/L5/S1/S2/S3 nerve roots (sciatic nerve). For the sciatic nerve, incomplete paralysis warrants a 10 percent rating when mild, a 20 percent rating when moderate, a 40 percent rating when moderately severe, a 60 percent rating when severe with marked muscular atrophy, and an 80 percent rating for complete paralysis; the 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 lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis given with each nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The Board notes that words such as mild, moderate, and severe are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Prior to October 8, 2018 For the period prior to October 8, 2018, the Veteran’s left lower extremity peripheral neuropathy was rated as 10 percent pursuant to Diagnostic Code 8520. 38 C.F.R. § 4.124a. At the September 2014 VA examination, muscle strength testing was normal and straight leg raising was negative. The Veteran had mild left lower extremity constant pain, no intermittent pain, mild left lower extremity paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. The examiner indicated that the Veteran’s radiculopathy was mild and involved the sciatic nerve roots. In light of the foregoing evidence, the Board finds that the left lower extremity peripheral neuropathy was not more than mild in severity for the relevant appeal period at issue. The deficit shown was sensory in nature with normal muscle strength. The disability picture approximates the criteria for mild incomplete paralysis of the sciatic nerve under Diagnostic Code 8520 and warrants no more than a 10 percent rating for the left lower extremity. Since October 8, 2018 As noted, the Veteran’s left lower extremity peripheral neuropathy was increased to 20 percent disabling effective October 8, 2018, the date of his most recent examination. At the October 2018 VA examination, muscle strength testing was reduced and straight leg raising was positive. The Veteran had moderate constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. Deep tendon reflexes were normal. There was no muscle atrophy. The examiner indicated that the Veteran’s radiculopathy was moderate and involved the sciatic nerve roots. In light of the foregoing evidence, the Board finds that the left lower extremity peripheral neuropathy was not more than moderate in severity for the relevant appeal period at issue. The deficit shown involved muscle strength and sensation but no muscle atrophy. The disability picture approximates the criteria for moderate incomplete paralysis of the sciatic nerve under Diagnostic Code 8520 and warrants no more than a 20 percent rating for the left lower extremity. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Earlier Effective Date – Left Lower Extremity Peripheral Neuropathy The Veteran’s attorney generally contends that an earlier effective date is warranted for the award of service connection for peripheral neuropathy of the left lower extremity. Specific argument in support of this appeal was not provided. The Veteran submitted an informal claim for an increased rating for his service-connected lumbar spine disability on January 30, 2014. An October 2014 rating decision awarded service connection for left lower extremity peripheral neuropathy as secondary to the service-connected lumbar spine disability. The award of service connection for the left lower extremity was assigned to be effective January 30, 2014, the date that the informal claim for benefits was received. The basis for the grant was that the peripheral neuropathy of the left lower extremity was secondary to the service-connected lumbar spine disability. The record contains no earlier statements that could be construed as an informal claim. The effective date for a grant of service connection is the day after separation from service or day entitlement arose, if a claim is received within one year of separation from service, otherwise the date of receipt of claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110 (b)(1); 38 C.F.R. § 3.400(b)(2)(i). A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1(p), 3.151, 3.155; Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999). Treatment records do not constitute informal claims when service connection has not yet been established for the condition. 38 C.F.R. § 3.157; Sears v. Principi, 16 Vet. App. 244 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). A specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly-authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered as filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). Under 38 C.F.R. § 3.157(a), a report of examination or hospitalization will be accepted as an informal claim for increase or to reopen, if the report relates to a disability that may establish entitlement. However, there must first be a prior allowance or disallowance of a claim. See 38 C.F.R. § 3.157(b). After careful consideration of the evidence, to include written communications from the Veteran and the medical record, the Board finds that there is no basis for an effective date prior to January 30, 2014, for peripheral neuropathy of the left lower extremity. Neither the Veteran nor his representative submitted any written correspondence which could be construed as a formal or informal claim for entitlement to service connection for peripheral neuropathy of the left lower extremity prior to January 30, 2014. There is simply no authority in law which would permit a grant of an earlier effective date. Therefore, the Board finds that an effective date prior to January 30, 2014, for the award of service connection for peripheral neuropathy of the left lower extremity is not warranted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cryan, Alicia, Counsel