Citation Nr: 18157181 Decision Date: 12/12/18 Archive Date: 12/11/18 DOCKET NO. 18-21 937 DATE: December 12, 2018 ORDER Entitlement to service connection for neuropathy of the left upper extremity, to include as secondary to the service-connected back disability is denied. Entitlement to service connection for neuropathy of the right upper extremity, to include as secondary to the service-connected back disability is denied. Entitlement to service connection for neuropathy of the left lower extremity, to include as secondary to the service-connected back disability is denied. Entitlement to service connection for neuropathy of the right lower extremity, to include as secondary to the service-connected back disability is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD), to include as secondary to the service-connected back disability is denied. Entitlement to a rating in excess of 40 percent for a lumbar spine disability is denied. Entitlement to a compensable rating for a thoracic spine disability is denied. REMANDED Entitlement to an earlier effective date for service connection for neuropathy of the left upper extremity, to include as secondary to service-connected back disability is remanded. Entitlement to an earlier effective date for service connection for neuropathy of the right upper extremity, to include as secondary to service-connected back disability is remanded. Entitlement to an earlier effective date for service connection for neuropathy of the left lower extremity, to include as secondary to service-connected back disability is remanded. Entitlement to an earlier effective date for service connection for neuropathy of the right lower extremity, to include as secondary to service-connected back disability is remanded. Entitlement to an earlier effective date for service connection for PTSD, to include as secondary to the service-connected back disability is remanded. Entitlement to an effective date earlier than February 11, 2011 for the grant of service connection for mood disorder is remanded. Entitlement to an initial rating in excess of 70 percent for a mood disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The competent, probative evidence of record fails to relate neuropathy of the left upper extremity to a service-connected disability. 2. The competent, probative evidence of record fails to relate neuropathy of the right upper extremity to a service-connected disability. 3. The competent, probative evidence of record fails to relate neuropathy of the left lower extremity to a service-connected disability. 4. The competent, probative evidence of record fails to relate neuropathy of the right lower extremity to a service-connected disability. 5. There is no competent evidence of record showing that the Veteran has a diagnosis of PTSD. 6. For the entire period on appeal, the Veteran’s lumbar spine disability is not manifested by ankylosis. 7. The rating criteria in effect since September 26, 2003, does not allow for separate ratings for the lumbar and thoracic spine. CONCLUSIONS OF LAW 1. The criteria for service connection for neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (West 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(f), 4.125(a) (2017). 6. The criteria for a rating in excess of 40 percent for a lumbar spine disability have not been met. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2017). 7. The criteria for a compensable rating for a thoracic spine disability have not been met. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1977 to January 1997. Service Connection The Veteran is seeking service connection for neuropathy for right and left upper and lower extremities that he states are proximately due to his service connected disabilities. Specifically, in an April 2013 statement, the Veteran specifically stated that his neuropathy is due to his service-connected back disabilities. When determining entitlement to service connection, the Board is required to consider all theories of entitlement reasonably raised by the record. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (the Board is required to weigh all theories of entitlement raised either by the claimant or by the evidence). Here, however, this Veteran’s claims are entirely predicated on the notion these additional disorders are secondary to his service-connected disabilities of the lumbar and thoracic spines. He does not allege, and the evidence does not otherwise suggest, that any of these disorders were directly or even presumptively incurred in service. See 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). As such, the Board finds that the Veteran is seeking entitlement to service connection for these disorders on a secondary basis only. With regard to secondary service connection, a disability can be service-connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may also be established by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Neuropathy of the left and right upper and lower extremities The Board concludes that, while the Veteran has current diagnoses of idiopathic peripheral neuropathy of the left and right upper and lower extremities (see May 2013 VA examination) the preponderance of the evidence is against a finding that any of these disorders are proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability or disabilities, to include the service-connected back disabilities. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The available VA and private treatment records show the Veteran has received treatment for the claimed disorders throughout the appeals period. Importantly, however, the treatment records do not contain any etiological opinions attributing these disorders to the service-connected back disabilities. In May 2013, the Veteran was provided a VA examination regarding these claims. The VA examiner confirmed the diagnoses of idiopathic peripheral neuropathy of the upper and lower extremities, bilaterally. However, it was ultimately concluded that the peripheral neuropathy of the right and left upper and lower extremities is less likely than not due to or the result of the Veteran’s military service. Regarding the bilateral lower extremities, the examiner stated that the Veteran had decreased sensation in the toes and feet. The examiner explained that neuropathy is sensation based and does not follow a pattern of nerve compression or radiculopathy coming from the lower back, as the numbness is only present in the feet and lower legs, and does not appear in the upper legs. Therefore, it is less likely than not that the current bilateral lower extremity neuropathy is related to the Veteran’s thoracic or lumbar spine disabilities. Concerning the bilaterally upper extremities, it was noted the Veteran had decreased sensation in the hands and evidence of possible carpal tunnel syndrome. Again, it was explained that the Veteran’s neuropathy is sensation based and does not follow a pattern of nerve compression or radiculopathy coming from the lower back. The upper extremity nerves are not in the same anatomical location/or do they stem from the same region as the degenerative changes in the back. Further, the examiner stated there is no medical literature to support a finding of neuropathy of the upper extremities with that of degenerative disc disease in the thoracic and lumbar spine. Therefore, it is less likely than not that the current bilateral upper extremity neuropathy is related to the Veteran’s thoracic or lumbar spine disabilities. The Veteran underwent a VA examination of the spine in May 2017. During the examination, there was no evidence of radiculopathy to account for the Veteran’s symptoms in his upper and lower extremities, and no additional opinions regarding the diagnosed peripheral neuropathy were rendered. Based on the foregoing, the Board concludes that the evidence is against the service connection claims. The May 2013 VA examiner found the Veteran’s diagnosed peripheral neuropathy of the bilateral upper and lower extremities was not related to service. This examiner conducted a comprehensive clinical examination and evidentiary review, and indicated familiarity with the Veteran’s pertinent medical and lay history. The examiner provided a rationale regarding the Veteran’s current conditions and offered adverse opinions regarding the relationship between the Veteran’s diagnosed disorders and his service-connected disabilities. There are no conflicting opinions. Specifically, the evidence fails to show that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities is proximately due to or the result of, or aggravated beyond its natural progression by the service connected lumbar or thoracic spine disabilities. The Board has also considered the Veteran’s statements that his current disorders are proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability or disabilities. The Veteran is certainly competent to state when he was initially diagnosed with the disorders, or when physical symptoms presented themselves, such as pain and tingling or loss of sensation. Lay persons, however, are not competent to attribute these disabilities to his military service. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Veteran is also not competent to state what caused any associated underlying symptoms, where it has not been shown that he has a medical background to provide an opinion as to such. The Federal Circuit has recognized the Board’s “authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence.” Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Accordingly, service connection for peripheral neuropathy of the right and left upper and lower extremities is not warranted because the Veteran has not satisfied the nexus requirement of attributing the current disorders to his service connected disabilities on a secondary basis. See 38 C.F.R. § 3.310 (2017). In reaching the above conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine does not apply. 38 U.S.C. § 5107(b) (West 2012). The claims of entitlement to service connection for peripheral neuropathy of the right and left upper and lower extremities are denied. 2. PTSD The Veteran is seeking entitlement to service connection for PTSD that he claims is the result of his military service. Specifically, he states that during his time in service, he was involved in top secret missions and he cannot say anymore. Alternatively, he asserts that his PTSD is secondary to his service-connected lumbar and thoracic spine disabilities. As an initial matter, the Board points out that the Veteran is currently service-connected for a mood disorder, which is also on appeal. Therefore, any evidence pertaining to the symptomatology associated with that disability will not be discussed in the context of the claim for service connection for PTSD. Service connection for PTSD, in particular, requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a) (2017); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) a link, established by medical evidence, between the current symptoms and the claimed in-service stressor. 38 C.F.R. § 3.304 (f) (2017); see also Cohen v. Brown, 10 Vet. App. 128 (1997). The Board has carefully reviewed the extensive evidence but finds that service connection for PTSD is not warranted. In this regard, the Board points out that a key element in establishing service connection is to show that a veteran currently has a diagnosis of the disability for which service connection is sought. See 38 C.F.R. § 3.304. The Veteran was scheduled for a VA psychiatric examination dated in May 2013. The May 2013 VA examiner determined the Veteran does not meet the full criteria for a diagnosis of PTSD as there is no evidence of exposure to a traumatic event. The only diagnosis provided was mood disorder, for which the Veteran is currently receiving compensation. In support of his claim, the Veteran submitted a Disability Benefits Questionnaire (DBQ) dated in June 2014 and signed by a private psychologist. However, this DBQ also does not provide a diagnosis of PTSD, noting only an Axis I diagnosis of mood disorder. The Veteran was most recently examined in May 2017. Again, a diagnosis of PTSD in accordance with the criteria set forth in the DSM 5 was not provided. The Board observes that a VA treatment record “ Problem List,” dated in March 2011 contains a notation of PTSD as an “active problem.” Additional VA treatment records also refer to a diagnosis of PTSD during the appeals period. However, there is no discussion in these records of consideration of the criteria for PTSD, to include a reference to in-service traumatic events that would qualify as a stressor. Moreover, these records fail to relate PTSD to the Veteran’s service in any capacity. Consequently, the Board affords more weight to the May 2013 and May 2017 VA examinations and June 2014 private DBQ that conducted thorough mental examinations of the Veteran and reviewed the available VA and private treatment records when rendering the findings noted above that excluded rendering a diagnosis of PTSD. Therefore, the Board finds the evidence does not show that PTSD has been diagnosed in accordance with 38 C.F.R. § 4.125, despite the Veteran’s contentions to the contrary during the appeal period. Since regulations require medical evidence diagnosing the claimed condition, the Veteran’s self-assessment is not competent 38 C.F.R. § 3.304. In this respect, a clinical professional has the greater skill. As such, the Board concludes that there is no reliable and/or probative evidence showing that the Veteran has PTSD. In the absence of a diagnosis, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board thus finds that the preponderance of the evidence is against the claim and service connection is denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1 (2017); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017). 3. Entitlement to a rating in excess of 40 percent for a lumbar spine disability The Veteran is seeking a rating in excess of 40 percent for a low back disability pursuant to the provisions of Diagnostic Code 5242, 38 C.F.R. § 4.71a. As indicated on the May 2014 Notice of Disagreement, the Veteran is seeking the maximum benefits allowable under the law, which includes consideration of the assigned effective date. Here, the Board finds that the Veteran’s claim for an increased rating was received on September 14, 2010. While the Board is not increasing the Veteran’s rating and, therefore, any consideration of this factual determination for effective date purposes is considered harmless error, this determination is necessary for limited purpose of determining the relevant temporal focus for this appeal, which is from September 14, 2009, one year prior to the date of receipt of the claim. 38 C.F.R. § 3.400. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). A United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The Veteran’s lumbar spine disability has been rated under Diagnostic Code 5242, the criteria for evaluating degenerative arthritis of the spine. The criteria for rating the Veteran’s disability is set forth in a General Rating Formula for evaluating diseases and injuries of the spine. See 38 C.F.R. § 4.71a. Under Diagnostic Code 5242, a 50 percent rating is assigned when there is unfavorable ankylosis of the thoracolumbar spine only. A 100 percent rating is assigned when there is unfavorable ankylosis of the entire spine. As described above, the higher rating for 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71, Diagnostic Code 5242. The Court, citing Dorland’s Illustrated Medical Dictionary (28th ed. 1994), has recognized that ankylosis is defined as “immobility and consolidation of a joint due to disease, injury or surgical procedure,” for VA compensation purposes. See Colayong v. West, 12 Vet. App. 524, 528 (1999); Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). The General Rating Formula for Diseases and Injuries of the Spine, provide further guidance in rating diseases or injuries of the spine. In pertinent part, Note (1) provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Here, as the Veteran has separately claimed entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities as secondary to his back disability, as discussed above, the Board will not again address neurological manifestations of the Veteran’s extremities below. However, consideration to other neurological manifestations will still be addressed. As mentioned, the next higher rating for 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71, Diagnostic Code 5242. During the May 2013 VA examination, the Veteran denied the existence of flare-ups. Range of motion testing revealed flexion to 65 degrees, extension to 25 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 20 degrees. All movement resulted in pain, but the Veteran was able to perform repetitive testing. Further, all additional range of motion testing revealed the same degree of movement in the Veteran’s lumbar spine, but the examiner did also note that pain and less movement than normal contributed to functional limitations. There was also evidence of localized tenderness, and guarding and muscle spasm resulting in abnormal gait or abnormal spinal contour. As for neurological manifestations, the examiner noted there was no evidence of neurological manifestations, such as bowel or bladder impairment or radiculopathy. The examiner also indicated the Veteran does not suffer from intravertebral disc disease (IVDS). There was no indication of ankylosis. The examiner finally noted that the Veteran required the use of a cane. The Veteran was next examined in May 2017 to determine the nature and severity of his lumbar spine disability. At that time, the Veteran again denied the existence of flare-ups. Range of motion testing revealed flexion to 90 degrees, extension to 20 degrees, right lateral flexion to 30 degrees, left lateral flexion to 25 degrees, and right and left lateral rotation to 30 degrees. All movement resulted in pain, but the Veteran was able to perform repetitive testing. Further, all additional range of motion testing revealed the same degree of movement in the Veteran’s lumbar spine, but the examiner did also note that pain and less movement than normal contributed to functional limitations. There was also evidence of pain on weight-bearing, localized tenderness, and guarding. However, there was no evidence of muscle spasm resulting in abnormal gait or abnormal spinal contour. As for neurological manifestations, the examiner noted there was no evidence of neurological manifestations, such as bowel or bladder impairment or radiculopathy. The examiner also indicated the Veteran does not suffer from IVDS. There was no indication of ankylosis. The examiner finally noted that the Veteran required the use of a cane. Additionally, there are a significant number of VA and private treatment records. Unfortunately, these treatment records do not contain any evidence that the Veteran suffers from ankylosis to warrant the higher 50 percent rating. Therefore, even considering any additional functional impact of the Veteran’s lumbar spine as noted above and his reports of pain, the fact remains the Veteran retains motion in his lumbar spine which precludes a finding of ankylosis. The Board finds that even when considering functional limitations due to pain and the other factors identified in 38 C.F.R. §§ 4.40, 4.45 4.59 as well as the criteria in DeLuca and Mitchell, the Veteran’s functional loss did not equate to the criteria required for a 50 percent rating. Further, to the extent the May 2013 or May 2017 VA examinations failed to comply with the holdings in Correia or Sharp, either individually or collectively, such non-compliance is harmless error. In this respect, the Court in Johnston, supra, indicated that where the Veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, the cited regulations are not for application. Johnston, 10 Vet. App. at 84-85 (although the Secretary suggested remand because of the Board’s failure to consider functional loss due to pain, remand was not appropriate because higher schedular rating required ankylosis). Thus, as the Veteran is in receipt of the maximum schedular rating based on limitation of motion and a higher rating requires ankylosis of other symptoms unrelated to limitation of motion, 38 C.F.R. § 4.40 and 4.45 are not for application. Finally, the Board need not consider the applicability of the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes as there is no evidence of record indicating the Veteran suffers from IVDS. There is no additional medical evidence, as discussed in detail above, which would support the Veteran’s contentions that his lumbar spine disability has increased in severity beyond the currently assigned 40-percent rating. In addition to considering the orthopedic manifestations of a lumbar spine disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. In this respect, the Veteran has specifically denied the neurological symptoms of radiculopathy and weakness or loss of bowel or bladder control. Further, neither the May 2013 nor the May 2015 VA examinations noted the presence of neurological manifestations of the lumbar spine. In reaching the above conclusions, the Board has not overlooked the Veteran’s statements with regard to the severity of his low back disability. In this regard, the Veteran is competent to report on factual matters of which he had firsthand knowledge, e.g., experiencing chronic pain in his back. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran has provided lay evidence through written statements throughout the course of his appeal with respect to the presence of pain and the severity of such during his VA examinations. He is competent to provide such statements, and the Board finds that the Veteran’s statements are credible. The Veteran’s reported symptomatology has been noted in the rating decisions above, and the Board has considered the Veteran’s reports with respect to pain in evaluating his assigned rating. With respect to the Rating Schedule, the criteria set forth therein generally require medical expertise where the types of findings required are not readily observable by a lay person. Therefore, the objective medical findings provided by the Veteran’s VA examination reports have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (“[t]he probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches... the credibility and weight to be attached to these opinions [are] within the province of the adjudicator.”). As a preponderance of the evidence is against the award of an increased rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). 4. Entitlement to a compensable rating for a thoracic spine disability The Veteran is seeking an entitlement to a compensable rating for the thoracic spine. By way of history, the Board notes that the Veteran was previously in receipt of a 10 percent rating for this disability pursuant to Diagnostic Code 5291. In a May 1999 rating decision, the RO decreased the Veteran’s thoracic spine rating to 0 percent while at the same time increasing the rating for the lumbar spine (discussed above) to 40 percent, effective from November 13, 1998. As this 0 percent rating has been in effect for at least 20 years, it is considered a protected rating. 38 C.F.R. § 3.951 (b). By regulatory amendment, effective from September 26, 2003, VA revised the regulations with respect to the spine under the General Rating Formula for Diseases and Injuries of the Spine, as discussed above. Since this claim was received in September 2010, well after the revised criteria went into effect, only the amended rating criteria are applicable in this case. Therefore, as the revised criteria are in terms of the thoracolumbar spine-with thoracic and lumbar disabilities rated together-any disability associated with the thoracic spine is contemplated by the rating assigned under the revised criteria for the service connected lumbar spine disability. As such, a separate compensable rating for the service connected thoracic spine disability under the revised criteria would be tantamount to pyramiding, which is forbidden under 38 C.F.R. § 4.14. See Brady v. Brown, 4 Vet. App. 203, 206 (1993) (noting the 38 C.F.R. § 4.14 prohibits employing the rating schedule as a vehicle for compensating a claimant twice or more for the same symptomatology because such would overcompensate the claimant for the actual impairment of his or her earning capacity). As a preponderance of the evidence is against the award of an increased rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). REASONS FOR REMAND 1. Entitlement to earlier effective dates for the claims of entitlement to service connection for PTSD, and bilateral peripheral neuropathy of the upper and lower extremities; and, the grant of service connection for mood disorder are remanded. In his May 2014 Notice of Disagreement, the Veteran expressly indicated disagreement with the assignation of effective dates for his claims of entitlement to service connection for PTSD, and bilateral peripheral neuropathy of the upper and lower extremities; and, the grant of service connection for mood disorder, effective from February 11, 2011. Specifically, concerning the claims of entitlement to service connection for bilateral peripheral neuropathy of the upper and lower extremities and the grant of service connection for mood disorder, the Veteran is arguing that a Statement in Support of Claim, signed by the Veteran on September 8, 2010 and received by VA on September 14, 2010, should serve as the date of his claims and not a February 2011 Report of General Contact. The Board notes that this matter is particularly relevant as it pertains to the claim regarding an earlier effective date for his service-connected mood disorder as the RO determined service connection was warranted for this disability effective from February 11, 2011 and not from September 14, 2010, as the Veteran is arguing. To date, a statement of the case has not yet been issued as to the effective dates issues concerning these claims and a remand is required for the AOJ to do so. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 2. Entitlement to an initial rating in excess of 70 percent for mood disorder and TDIU are remanded. The issues of entitlement to an initial rating in excess of 70 percent for mood disorder and entitlement to a TDIU must also be remanded as the development sought could impact the outcome of these claims. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). The matters are REMANDED for the following action: 1. Send the Veteran and his attorney a statement of the case that addresses the issue of entitlement to earlier effective dates for the claims of entitlement to service connection for PTSD, and bilateral peripheral neuropathy of the upper and lower extremities; and, the grant of service connection for mood disorder. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issue should be returned to the Board for further appellate consideration. 2. The AOJ should then take any further action deemed appropriate regarding the merits of the claims of entitlement to an initial rating in excess of 70 percent for a mood disorder and entitlement to a TDIU. 3. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berry, Counsel