Citation Nr: 18157418 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 14-15 546 DATE: December 12, 2018 ORDER Entitlement to an effective date earlier than June 16, 2010 for the grant of service connection for sinusitis is denied. Entitlement to an effective date earlier than June 16, 2010 for the grant of service connection for allergic rhinitis is denied. Entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 40 percent for benign prostatic hypertrophy with history of prostatitis (hereinafter “prostate disability”) is denied. Entitlement to a rating in excess of 40 percent for a prostate disability is denied. Entitlement to a rating in excess of 10 percent for sinusitis is denied. Entitlement to a compensable rating for residuals of tailbone injury with coccyx pain (hereinafter “tailbone disability”) is denied. Entitlement to a compensable rating for hemorrhoids is denied. Entitlement to an initial compensable rating for allergic rhinitis is denied. REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a left eye disability is remanded. Entitlement to a rating in excess of 20 percent for a lumbar strain is remanded. Entitlement to a rating in excess of 10 percent for right knee chondromalacia with degenerative changes (hereinafter “right knee disability”) is remanded. Entitlement to service connection for right lower extremity radiculopathy, secondary to service-connected lumbar strain, is remanded. Entitlement to service connection for left lower extremity radiculopathy, secondary to service-connected lumbar strain, is remanded. Entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 20 percent rating for a lumbar strain is remanded. Entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 10 percent for a right knee disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran filed a claim for entitlement to service connection for sinusitis in June 2010. There is no evidence of any communication in the claims file prior to the June 2010 claim indicating intent to file a claim for this disability. 2. The Veteran filed a claim for entitlement to service connection for allergic rhinitis in June 2010. There is no evidence of any communication in the claims file prior to the June 2010 claim indicating intent to file a claim for this disability. 3. The Veteran filed a claim for entitlement to an increased rating for his service-connected prostate disability in June 2010. There is no evidence of any communication in the claims file prior to the June 2010 claim indicating intent to file a claim for this disability, and it is not factually ascertainable that an increased in disability occurred within one year from the date of claim. 4. The Veteran’s prostate disability has been manifested by voiding dysfunction requiring the wearing of absorbent materials which must be changed two to four times per day. Voiding dysfunction requiring the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day has not been shown. 5. The Veteran has not been shown to suffer from any incapacitating episodes of sinusitis requiring prolonged antibiotic treatment in the past 12 months, nor did he suffer from more than six non-incapacitating episodes of sinusitis in the past 12 months. 6. The Veteran’s tailbone disability has not manifested in painful residuals. 7. The Veteran’s hemorrhoids have been no more than moderate in degree and have not been productive of large or thrombotic hemorrhoids that are irreducible and have excessive redundant tissue, evidencing frequent occurrences; persistent bleeding with secondary anemia or with fissures has also not been demonstrated. 8. The Veteran’s allergic rhinitis has not resulted in greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side, and there is no evidence of nasal polyps. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than June 16, 2010 for the grant of service connection for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.155, 3.157, 3.400. 2. The criteria for an effective date earlier than June 16, 2010 for the grant of service connection for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.155, 3.157, 3.400. 3. The criteria for an effective date earlier than June 16, 2010 for the grant of an increased 40 percent rating for a prostate disability have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.155, 3.157, 3.400. 4. The criteria for a rating in excess of 40 percent for a prostate disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.115(a), (b), Diagnostic Code (DC) 7527. 5. The criteria for a rating in excess of 10 percent for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.97, DC 6513. 6. The criteria for a compensable rating for a tailbone disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71(a), DC 5299-5298. 7. The criteria for a compensable rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, DC 7336. 8. The criteria for an initial compensable rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.97, DC 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1972 to November 1996. This appeal arose to the Board of Veterans’ Appeals (Board) from a February 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Decatur, Georgia. In January 2016, the Board remanded the matters on appeal for evidentiary development. During the pendency of this appeal, in a February 2014 rating decision, the RO found clear and unmistakable error in the assigned ratings for the Veteran’s prostate disability and lumbar strain, and increased those ratings to 40 percent and 20 percent, respectively, effective June 16, 2010. Additionally, in a June 2016 rating decision, the RO granted an increased 10 percent rating for the Veteran’s sinusitis. Because higher ratings are available for those disabilities, and the Veteran is presumed to seek the maximum available benefit, the increased rating claims remain on appeal. See Fenderson v. West, 12 Vet. App. 119 (1999); AB v. Brown, 6 Vet. App. 35 (1993). Earlier Effective Date Claims 1. Entitlement to an effective date earlier than June 16, 2010 for the grant of service connection for sinusitis and allergic rhinitis The Veteran seeks entitlement to an effective date earlier than June 16, 2010 for the grant of service connection for sinusitis and allergic rhinitis. For the following reasons, the Board finds earlier effective dates are not warranted. The assignment of an effective date for an award of service connection is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increased compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized formal and informal claims. The amendments also, inter alia, eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155 (2016). The amended regulations, however, apply only to claims filed on or after March 24, 2015. In this case, the Veteran filed an application for entitlement to service connection received on June 16, 2010. Service connection for sinusitis and allergic rhinitis was subsequently granted, and an effective date of June 16, 2010, was assigned for these disabilities, based on the date VA received the claim. The Board has carefully reviewed the record to determine whether any communications by or on behalf of the Veteran were submitted prior to his current effective date that could be construed as a claim for service connection. See 38 C.F.R. § 3.1(p) (2014). The Board finds that there are no communications of record that could serve as the basis for an earlier effective date under 38 U.S.C. § 5110(a). Although the Veteran had submitted an earlier claim for service connection for allergic rhinitis, this claim was denied in a May 1998 rating decision, and the Veteran did not perfect an appeal. As such, that decision was considered final on May 26, 1999, one year after notification. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The Board acknowledges that the record shows the Veteran likely had sinus symptoms and allergies prior to the June 16, 2010 effective date. Notwithstanding, while clinical records were previously recognized, in some instances, as informal claims under 38 C.F.R. § 3.157(b) (2014), this applied only if the evidence pertained to examination or treatment of a disability for which service connection had been previously established, or when a claim specifying the benefit sought was received within one year from the date of such examination, treatment or hospital admission. The Veteran does not assert, and the evidence of record does not reflect, that either situation applies here. In sum, having reviewed all communications in the claims file, the Board finds that there is no probative evidence that the Veteran submitted any formal or informal communications with respect to his sinusitis or allergic rhinitis, subsequent to receiving notice of the prior denial in May 1998 and prior to his June 2010 claim. See 38 C.F.R. § 3.1(p) (2014). Thus, there is no legal basis for awarding an effective date earlier than June 16, 2010. 2. Entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 40 percent rating for a prostate disability The Veteran contends that he is entitled to an effective date earlier than June 16, 2010, for the grant of an increased 40 percent rating for his service-connected prostate disability. For the following reasons, the Board finds an earlier effective date not warranted. As noted above, unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increased compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. More specifically, according to Harper v. Brown, 10 Vet. App. 125, 126 (1997), in the case of claims for earlier effective dates for awards of increased compensation, three possible effective dates may be assigned: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (the date entitlement arose) (38 C.F.R. § 3.400(o)(1)); (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (i.e., the date the increase is factually ascertainable) (38 C.F.R. § 3.400(o)(2)); or (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (38 C.F.R. § 3.400(o)(2)). In summary, determining the appropriate effective date for an increased rating under the effective date statues and regulations involves an analysis of the evidence to determine (1) when a claim for an increased rating was received, and, if possible, (2) when the increase in disability actually occurred. 38 C.F.R. § 3.155, 3.400(o)(2). Here, the Veteran filed his claim for an increased rating for a prostate disability on June 16, 2010. Following an examination, the Veteran’s claim for increase was granted, with an award of 40 percent made effective on June 16, 2010. The Board has carefully reviewed the record to determine whether any communications by or on behalf of the Veteran were submitted prior to his current effective date that could be construed as a claim for increased compensation for his prostate disability. See 38 C.F.R. § 3.1(p) (2014). The Board finds that there are no communications of record that could serve as the basis for an earlier effective date under 38 U.S.C. § 5110(a). The Board has also considered the earliest date on which it is factually ascertainable that an increase in the Veteran’s prostate disability symptomatology occurred, in particular within one year from the June 2010 claim for increase. However, on review, there is simply no probative evidence demonstrating that the criteria for a 40 percent rating were met prior to the date of the Veteran’s claim. See 38 C.F.R. § 4.115(a). Specifically, a review of the Veteran’s VA medical records from the year prior to receipt of his June 2010 claim do not demonstrate that he suffered from urine leakage, urinary diversion, urinary incontinence, or stress incontinence requiring the wearing of absorbent materials that must be changed two to four times per day. In so finding, the Board has considered the provisions of 38 C.F.R. § 3.157(b) (2014) regarding the function of certain medical records serving as informal claims for increase. In sum, having reviewed all communications in the claims file, the Board finds that there is no probative evidence that the Veteran submitted any formal or informal communications with respect to his prostate disability prior to June 2010 that could be construed as an informal claim for increased compensation, nor is it factually ascertainable that an increase in disability occurred during the one-year period prior to the June 2010 date of claim. See 38 C.F.R. §§ 3.1(p), 3.157(b) (2014). Thus, there is no legal basis for awarding an effective date earlier than June 16, 2010. Increased Rating Claims Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the current level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, separate evaluations for separate and distinct symptomatology may be assigned where none of the symptomatology justifying an evaluation under one DC is duplicative of or overlapping with the symptomatology justifying an evaluation under another DC. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Additionally, if two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. When assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must, in addition to applying schedular criteria, also consider evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-207 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). 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 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. 1. Entitlement to a rating in excess of 40 percent for a prostate disability The Veteran contends that he is entitled to a rating in excess of 40 percent for his service-connected prostate disability (characterized by the RO as benign prostatic hypertrophy with history of prostatitis). For the following reasons, the Board finds that an increased rating is not warranted. The Veteran’s symptoms are rated under DC 7527. See 38 C.F.R. § 4.115(b). DC 7527 provides that prostate gland injuries, infections, hypertrophy, or postoperative residuals must be rated as voiding dysfunction or urinary tract infection, whichever is predominant. Id. The predominant symptoms pertaining to the Veteran’s prostate disability are most similar to those in the criteria for voiding dysfunction. See 38 C.F.R. § 4.20 (authorizing the rating of a condition according to the requirements of an analogous condition). There is no indication in the record that the Veteran has a history of urinary tract infections (moreover, the highest available schedular rating for urinary tract infection is 30 percent, pursuant to 38 C.F.R. § 4.115(a)). Section 4.115(a) states that voiding dysfunction is rated as urine leakage, urinary frequency, or obstructed voiding. With regard to urine leakage, a 40 percent rating is assigned for urine leakage, urinary diversion, urinary incontinence, or stress incontinence requiring the wearing of absorbent materials that must be changed two to four times per day. A 60 percent rating is assigned for continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence requiring the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day. 38 C.F.R. § 4.115(a). Notably, no rating higher than 40 percent is available for obstructed voiding. The Veteran’s July 2010 examination revealed that he was diagnosed with benign prostatic hypertrophy. The Veteran complained of urinary frequency and urgency; he was forced to urinate 20 to 30 minutes during his waking hours and urinate an average of three times per night. The Veteran complained of slowness and weakness of stream, post void dribbling, and a sensation of incomplete bladder emptying. The Veteran received a Compensation and Pension (C&P) examination in March 2016 in which he was diagnosed with benign prostatic hypertrophy with a history of prostatitis. The Veteran suffered from an enlarged prostate which required absorbent material which must be changed less than two times per day. The Veteran’s voiding dysfunction did not require the use of an appliance, but did cause increased urinary frequency with daytime voiding interval between one and two hours and nighttime awakening to void three to four times. The voiding dysfunction did not cause signs or symptoms of obstructed voiding. Having reviewed the evidence of record, the Board finds that a rating in excess of 40 percent is not warranted. In short, the preponderance of the lay and medical evidence demonstrates that the Veteran’s voiding dysfunction is manifested by urinary leakage requiring the changing of absorbent materials no more than four times per day. Moreover, there is no evidence that the Veteran requires the use of an appliance due to his voiding dysfunction. In sum, the criteria for a 60 percent rating have not been met at any point during the appeal period. See 38 C.F.R. § 4.115(b). As noted above, there is no basis for an increased rating under any of the other potentially applicable rating criteria. For the aforementioned reasons, the Board finds that the Veteran’s current 40 percent rating adequately compensates him for his prostate disability symptomatology. The weight of the evidence is against entitlement to an increased rating. 2. Entitlement to a rating in excess of 10 percent for sinusitis The Veteran contends that he is entitled to a rating in excess of 10 percent for his service-connected sinusitis. For the following reasons, the Board finds that an increased rating is not warranted. The Veteran’s sinusitis is rated under DC 6513. See 38 C.F.R. § 4.97. Under that DC, if sinusitis is detectable only by x-ray, then it is noncompensable. If sinusitis is productive of one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting, then a 10 percent rating is warranted. For a 30 percent rating, sinusitis must be productive of three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. Id. A review of the facts for the Veteran’s sinus disorder reveals the following: In November 2010, the Veteran received a C&P examination in which the examiner determined the Veteran suffered from six non-incapacitating episodes per year in which he experienced headaches, fevers, purulent drainage, and sinus pain. Although the Veteran had a history of incapacitating episodes, none of those episodes required antibiotic treatment. In March 2016, the Veteran underwent an additional C&P examination in which the examiner determined the Veteran suffered from four non-incapacitating episodes of sinusitis over the past 12 months. He did not suffer from any incapacitating episodes of sinusitis requiring prolonged antibiotic treatment in the past 12 months. In June 2017, the Veteran’s lawyer submitted a statement in which he acknowledged that the Veteran suffered from six non-incapacitating episodes of sinusitis. However, the lawyer believed the Veteran deserved a higher rating, as the Veteran’s symptoms interfered with his employment and caused him to miss almost an entire month of work. (The Board notes that the issue of entitlement to a TDIU is addressed in the Remand section below.) In addition to the examination reports and lay statements discussed above, the Board has reviewed the Veteran’s VA outpatient notes and determined that the records demonstrate that the Veteran has not suffered from three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. On review, the Board finds that the criteria for a 30 percent rating have not been met at any time during the appeal period. The Board acknowledges the Veteran’s general lay reports of sinusitis symptomatology, specifically that the Veteran’s symptoms interfere with his employment. Notwithstanding, he has never specifically asserted that his sinusitis has resulted in three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. On the contrary, the competent and probative C&P examination report reflect otherwise, and demonstrate that the criteria for an increased rating have not been met. In light of the lay and medical evidence discussed above, the Board finds that the most probative evidence of record demonstrates that the criteria for a 30 percent rating have not been met. Accordingly, the claim for an increased rating must be denied. 3. Entitlement to a compensable rating for a tailbone disability The Veteran contends that his tailbone disability is more severe than his current noncompensable rating reflects. His symptoms are rated under DC 5299-5298. See 38 C.F.R. § 4.71(a). Under DC 5298, a noncompensable rating is warranted for the removal of the coccyx without painful residuals. To earn a 10 percent rating, one must suffer from painful residuals of a partial or complete removal of the coccyx. Id. On review, the Board finds that the criteria for a compensable rating have not been met at any time during the appeal period. During a July 2010 C&P examination, the Veteran denied that his coccyx was ever removed, and reported no further injuries to his coccyx. However, he reported that he had pain in the tailbone area whenever sitting directly on the tailbone for long periods of time; as a result, he had to frequently shift his weight while sitting to avoid direct pressure. On physical examination, the examiner noted no tenderness on palpation over the coccyx. In March 2016, the Veteran underwent another C&P examination, which revealed that, based on diagnostic imaging, the Veteran did not suffer from any residuals of his tailbone injury. The Board acknowledges the Veteran’s general lay reports of pain on his tailbone. Notwithstanding, in this case the Board finds that the competent and probative findings of VA medical professionals outweigh any lay assertions of tailbone residuals. Here, there is simply no competent evidence to suggest that the Veteran’s coccyx has ever been partially or completely removed, as is required for a compensable rating. Moreover, while the Veteran reported some pain in his tailbone area in 2010, the examiner determined that there was no pain on palpation. In 2016, it was further observed that the Veteran had no residuals related to tailbone removal. In light of the lay and medical evidence discussed above, the Board finds that the most probative evidence of record demonstrates that the criteria for a compensable rating have not been met. Accordingly, the claim for an increased rating must be denied. 4. Entitlement to a compensable rating for hemorrhoids The Veteran contends that his hemorrhoids are more severe than his current noncompensable rating reflects. His symptoms are rated under DC 7336. See 38 C.F.R. § 4.114. Under that DC, a noncompensable rating is warranted for hemorrhoids that are mild or moderate; a 10 percent rating is warranted where there is evidence of large or thrombotic hemorrhoids, which are irreducible, with excessive redundant tissue, evidencing frequent recurrences; a maximum schedular rating of 20 percent is warranted where hemorrhoids are present, with persistent bleeding and secondary anemia, or with fissures. Id. On review, the Board finds that the criteria for a compensable rating have not been met at any time during the appeal period. An August 2010 C&P examination reflects that the Veteran had intermittent episodes of anal itching, rectal bleeding, and pain in the rectal area, especially with bowel movements. This occurred on average of two to three times per week. He denied any history of thrombosis, and reported taking Colace once every other day for stool softening, and applied Preparation H and suppositories to the rectal area three to four times per week. The examiner noted that there were occasional flare-ups of hemorrhoids, with the last flare-up coming months ago. A physical examination revealed the presence of a small, non-thrombosed hemorrhoid which was mildly tender to palpation. No other external lesions were noted. The Veteran was diagnosed with stable hemorrhoids. In March 2016, an additional C&P examination noted a diagnosis of mild to moderate external hemorrhoids with no evidence of bleeding or thrombosis. No functional impairment was indicated. The examiner noted that the Veteran had recurrent hemorrhoids with a history of thrombosed hemorrhoid. In addition to the VA examination reports discussed above, the Board has reviewed the Veteran’s VA outpatient notes, which reflects ongoing treatment for hemorrhoids with occasional flare-ups, often manifested by itching and treated with topical cream. These records provide no indication that the Veteran’s hemorrhoids have ever been large or thrombotic, irreducible, manifested by excessive redundant tissue, persistent bleeding, or prone to frequent recurrence. There is likewise no evidence that the Veteran has ever been treated for anemia or anal fissures. The Board acknowledges the Veteran’s general lay reports of hemorrhoid-related symptomatology, including pain and itching. Notwithstanding, he has never specifically asserted that his hemorrhoids have been large or thrombotic, irreducible, manifested by excessive redundant tissue, or prone to frequent recurrence. Rather, his lay statements are consistent with mild or moderate hemorrhoids, and thus align with his current noncompensable evaluation. In light of the lay and medical evidence discussed above, the Board finds that the most probative evidence of record demonstrates that the criteria for a compensable rating have not been met. Accordingly, the claim for an increased rating must be denied. 5. Entitlement to an initial compensable rating for allergic rhinitis The Veteran contends that his allergic rhinitis is more severe than his current noncompensable rating reflects. His symptoms are rated under DC 6522. See 38 C.F.R. § 4.97. Under that DC, a 10 percent rating is warranted for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. A 30 percent rating is warranted for allergic or vasomotor rhinitis with polyps. Id. In November 2010, the Veteran underwent a C&P examination, which revealed no signs of nasal obstruction. In March 2016, an additional C&P examination determined the Veteran did not suffer from greater than 50 percent obstruction of the nasal passage on both sides, and he did not suffer from complete obstruction of the left or right sides. No evidence of polyps was noted. In addition to the examination reports discussed above, the Board has reviewed the Veteran’s VA outpatient notes and determined that the records demonstrate that the Veteran has not suffered from nasal passage obstruction. On review, the Board finds that the criteria for a compensable rating have not been met at any time during the appeal period. The Board acknowledges the Veteran’s general lay reports of allergic rhinitis symptomatology. Notwithstanding, he has never specifically asserted that his rhinitis has resulted in blocked nasal passages to an extent that would warrant a compensable rating. As noted above, the competent and probative findings of VA medical examiners reflect no indication that the criteria for a compensable rating have been met. In light of the lay and medical evidence discussed above, the Board finds that the most probative evidence of record demonstrates that the criteria for a compensable rating have not been met. Accordingly, the claim for an increased rating must be denied. REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea In April 2018 correspondence, the Veteran’s layer requested an examination for the Veteran’s sleep apnea in order to determine whether or not his initial claim for insomnia (submitted following the Veteran’s separation from service) has a relationship with his subsequent diagnosis of sleep apnea. The Veteran’s lawyer asserted that what the Veteran mistakenly assumed was insomnia, and suffered from in service, was, in all actuality, sleep apnea. As such, an examination is in order to develop the chronology of the Veteran’s in-service insomnia and eventual diagnosis of sleep apnea and to determine whether or not a relationship exists between the two. See McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006) (discussing the circumstances under which VA’s duty to provide a VA examination are triggered). 2. Entitlement to service connection for a left eye disability The Veteran contends that he is entitled to service connection for a left eye disability, to include detachment of the left retina. In December 2010, a C&P examiner reviewed the case and determined the Veteran’s detached retina stemmed from a January 1999 diagnosis of “extensive lattice degeneration with atrophic retinal holes.” Given that the Veteran was discharged from service a little more than two years prior to this diagnosis, and the condition had existed long enough prior to the diagnosis to cause “extensive” damage, an additional examination is in order to ascertain the chronology of the Veteran’s lattice degeneration and to determine whether or not the condition existed in service or in the year following the Veteran’s discharge. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide an examination or obtain an opinion, it must ensure that the examination or opinion is adequate). 3. Entitlement to a rating in excess of 20 percent for lumbar strain, to include entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 20 percent rating In April 2018 correspondence, the Veteran’s lawyer contended that the Veteran suffers from serious flare-ups during which his lower back symptomatology is drastically worse than demonstrated in his most recent C&P examination. (At that examination, the Veteran stated that he did not suffer from flare-ups.) Accordingly, given the competent claims of worsening since the Veteran’s most recent examination, a new examination is in order prior to adjudication. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered “contemporaneous”). Furthermore, because the claim for an increased rating is being remanded for further development, the Board finds that the inextricably intertwined claim for an earlier effective date for the grant of an increased 20 percent rating must also be remanded. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). 4. Entitlement to a rating in excess of 10 percent for a right knee disability, to include entitlement to an effective date earlier than June 16, 2010 for the grant of an increased 10 percent rating In April 2018 correspondence, the Veteran’s lawyer contended that the Veteran suffers from serious flare-ups during which his right knee symptomatology is drastically worse than demonstrated in his most recent C&P examination. (At that examination, the Veteran stated that he did not suffer from flare-ups.) Accordingly, given the competent claims of worsening since the Veteran’s most recent examination, a new examination is in order prior to adjudication. See Green, 1 Vet. App. at 124; Caffrey, 6 Vet. App. at 381. Furthermore, because the claim for an increased rating is being remanded for further development, the Board finds that the inextricably intertwined claim for an earlier effective date for the grant of an increased 10 percent rating must also be remanded. See Tyrues, 23 Vet. App. at 177. 5. Entitlement to service connection for radiculopathy of the right and left lower extremities, secondary to service-connected lumbar strain At the Veteran’s March 2016 C&P examination, an examiner determined the Veteran did not suffer from radiculopathy of the right and left lower extremities, secondary to his service-connected lumbar spine disability. The Veteran has since submitted argument indicating that he continues to disagree with this determination. In April 2018 correspondence, his lawyer asserted that the Veteran continues to “consistently indicate the bilateral radicular presence – especially given period of flare-up/aggravation, and should be awarded accordingly.” Because the claim for an increased rating for the Veteran’s lumbar strain is being remanded for an updated examination, the Board finds that his claims for secondary radiculopathy must be remanded as well. See id. 6. Entitlement to TDIU During the pendency of the appeal, the Veteran has raised the issue of entitlement to a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). However, as this matter is inextricably intertwined with the remanded claims discussed above, it must be remanded as well. See Tyrues, 23 Vet. App. at 177. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his sleep apnea. The examiner must respond to the following: (a) State whether the criteria for a diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the disability was incurred in or otherwise related to the Veteran’s service, to include his in-service complaints of insomnia. (c) If it is determined that there is another likely etiology, that should be stated. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 2. Schedule the Veteran for an examination to determine the nature and etiology of his left eye disability, to include detached left retina and extensive lattice degeneration. (a) State whether the criteria for a diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the disability was incurred in or otherwise related to the Veteran’s service. (c) If it is determined that there is another likely etiology, that should be stated. (d) The examiner is asked to comment upon the December 2010 C&P examiner’s determination that the Veteran was diagnosed with extensive lattice degeneration in January 1999 and determine the chronology of the Veteran’s condition and whether or not the condition developed in service and or in the year following the Veteran’s discharge. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 3. Schedule the Veteran for an examination of the current severity of his service-connected lumbar strain. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to these disabilities, and discuss the effect of these disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for an examination of the current severity of his service-connected right knee disability. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to these disabilities, and discuss the effect of these disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 5. Schedule the Veteran for an examination to determine the nature and etiology of his right and left lower extremity radiculopathy. (a) State whether the criteria for a diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the disability was incurred in or otherwise related to the Veteran’s service, or caused by or aggravated by the Veteran’s lumbar spine disability. (c) If it is determined that there is another likely etiology, that should be stated. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 6. Following the Veteran’s examinations for his right knee and lumbar spine disabilities, and re-adjudication of those claims, re-adjudicate the Veteran’s claims for an earlier effective date for the grants of increased ratings for those disabilities. (Continued on the next page)   7. After the above development, and any additionally indicated development, has been completed, readjudicate the issues remaining on appeal, to include the issue of entitlement to a TDIU. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ryan, Associate Counsel