Citation Nr: 18106974 Decision Date: 06/01/18 Archive Date: 05/31/18 DOCKET NO. 14-33 961 DATE: June 1, 2018 ORDER Whether new and material evidence has been submitted to reopen a previously denied and final claim of service connection for a left shoulder injury is granted. Entitlement to service connection for a right shoulder injury is denied. Entitlement to service connection for deteriorated joints in the left hand is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for a heart condition is denied. Entitlement to service connection for deteriorated joints in the right hand is denied. Entitlement to service connection for foot fungus is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for right arm numbness is denied. Entitlement to an initial rating in excess of 40 percent for low back strain is denied. Entitlement to an initial rating of 30 percent for bilateral pes planus is granted prior to September 28, 2011. Entitlement to an initial rating in excess of 30 percent for bilateral pes planus, from September 28, 2011, is denied. Entitlement to an earlier effective date for the grant of service connection of right lower extremity radiculopathy is denied. REMANDED Entitlement to service connection of a traumatic brain injury (TBI) is remanded. Entitlement to service connection for a left shoulder injury is remanded. Entitlement to service connection for left arm numbness is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial compensable rating for left knee strain is remanded. Entitlement to an initial compensable rating for right knee strain is remanded. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is remanded. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is remanded. Entitlement to an earlier effective date for the grant of service connection for left lower extremity radiculopathy is remanded. Entitlement to an earlier effective date for the grant of total disability based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. New and material evidence has been submitted sufficient to reopen the previously denied and final claim of service connection for a left shoulder injury. 2. The preponderance of the evidence is against finding that the Veteran has degenerative changes of the right shoulder due to a disease or injury in service, to include his reported 1988 shoulder injury; The Veteran’s degenerative changes of the right shoulder did not manifest to a compensable degree within the applicable presumptive period. 3. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of degenerative changes in the left hand. 4. The preponderance of the evidence is against finding that the Veteran’s sleep apnea began during active service, or that he sustained any injury, illness or incident during service to which that diagnosis may be etiologically linked. 5. The Veteran’s various heart diagnoses did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established since surgery; the Veteran did not sustain an in-service incident, illness or injury to which his heart condition may be etiologically linked; The Veteran’s heart disability is neither proximately due to nor aggravated beyond its natural progression by his service-connected low back disability. 6. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of degenerative changes in the right hand. 7. The preponderance of the evidence is against finding that the Veteran’s tinea pedis began during active service, or is otherwise related to any in-service injury, event, or disease. 8. The preponderance of the evidence is against finding that the Veteran has headaches due to a disease or injury in service, to include his 1990 altercation in Thailand. 9. The preponderance of the evidence is against finding that the Veteran’s right arm numbness began during active service, or is otherwise related to an in-service injury, event, or disease. 10. The Veteran does not have ankylosis of the thoracolumbar spine or intervertebral disc syndrome. 11. For all periods on appeal, the Veteran’s bilateral pes planus has been manifested by symptoms including swelling on use, characteristic callosities, and pain on manipulation. 12. The first medical evidence of right lower extremity radiculopathy is dated June 17, 2014. CONCLUSIONS OF LAW 1. New and material evidence having been submitted, the claim of service connection for a left shoulder injury is reopened. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 2. The criteria for service connection for degenerative changes of the right shoulder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 3. The criteria for service connection for degenerative changes of the left hand joints are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for a heart disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a), 3.310(a). 6. The criteria for service connection for degenerative changes of the right hand joints are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 7. The criteria for service connection for foot fungus are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for headaches are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for right arm numbness are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for a rating in excess of 40 percent for low back strain have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, Diagnostic Codes (DCs) 5237, 5243. 11. The criteria for a 30 percent rating for bilateral pes planus have been met prior to September 28, 2011. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, DC 5276. 12. The criteria for a rating in excess of 30 percent for bilateral pes planus from September 28. 2011, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, DC 5276. 13. The criteria for effective date prior to June 17, 2014, for the grant of service connection of right lower extremity radiculopathy have not been satisfied. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1978 to April 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2011, April 2014, and July 2014 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. In addition, certain chronic diseases, including arthritis and arteriosclerosis, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (2017). 1. Whether new and material evidence has been submitted to reopen a previously denied and final claim of service connection for a left shoulder injury The Veteran seeks to reopen the previously denied and final claim of service connection for a left shoulder condition. The Board finds that the claim should be reopened. If a claim was previously denied by a RO or Board decision, and that RO or Board decision became final, then the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Even if the RO (in a rating decision, statement of the case, or supplemental statement of the case) has already determined that new and material evidence has been submitted, in the appeal, a new and material evidence analysis must still be completed by the Board. The requirement for the submission of new and material evidence is a jurisdictional prerequisite in order for a claimant to obtain review of a previously denied and final decision. 38 U.S.C. §§ 5108, 7104(b). In short, Board is under the statutory obligation to conduct a de novo review of the new and material evidence issue prior to adjudicating the underlying claims. Under 38 C.F.R. § 3.104(a), a decision of the rating agency shall be final and binding as to conclusions based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C. § 5104. A determination on a claim by the Agency of Original Jurisdiction (AOJ), of which the claimant is properly notified, is final if an appeal is not timely perfected. 38 C.F.R. § 20.1103 (2017). A rating decision becomes final one year after its issuance, unless a Notice of disagreement is filed. 38 C.F.R. § 20.302(a). If a notice of disagreement is filed, and a statement of the case is subsequently issued, a substantive appeal must be filed within 60 days from the date that the AOJ mails the statement of the case to the appellant, or within the remainder of the 1-year period from the date of the mailing of the underlying rating decision, which ever period ends later. 38 C.F.R. § 20.302(b). In general terms, “new” evidence is evidence that was not of record at the time that the prior final RO or Board decision was issued. “Material” evidence is evidence that addresses the element(s) of service connection that were deficient (and therefore the basis of denial) in the prior final RO or Board decision. See 38 C.F.R. § 3.156(a). The United States Court of Appeals for the Federal Circuit (Federal Court) has indicated that evidence may be considered new and material if it contributes, “to a more complete picture of the circumstances surrounding the origin of a Veteran’s injury or disability, even where it will not eventually convince the Board to alter its rating decision.” Hodge v. West, 115 F. 3d. 1356, 1363 (Fed. Cir. 1998). The claim on appeal was denied in a May 2008 rating decision. The Veteran did not file a notice of disagreement with that denial, and is subsequently became final. See Buie v. Shinseki, 24 Vet. App. 242 (2011). The claim in question was denied because the Veteran’s available medical records did not show a clinical diagnosis of a chronic left shoulder disability, although some symptoms were noted. The rating decision also noted that the Veteran failed to report for a scheduled VA examination. VA treatment records submitted since the time of that prior denial include July 2010 evidence of left shoulder pain, positive for crepitus, with decreased range of motion and a negative Hawkins/Neers test. The subsequent VA treatment records also indicate that the Veteran was prescribed physical therapy due to joint limitation and pain in the shoulder. The Board finds that this evidence is new in that it was not of record at the time of the prior denial. It is material in that it addresses a deficient criteria of service connection, namely a possible diagnosis of a chronic shoulder disability. As such, the claim is reopened. To this limited extent, the claim is granted. The underlying service connection claim is addressed in the below remand. 2. Entitlement to service connection for a right shoulder injury The Veteran seeks service connection for a right shoulder injury. The Board finds the claim should be denied. VA treatment records from October 2008 indicate pain in the right shoulder, with onset three months prior. No diagnosis was given. The Veteran was afforded a VA examination in October 2010 to assess his right shoulder disability. At that time, the Veteran reported that he started experiencing pain and limited motion in 1999. He also reported an injury during ranger training in 1988 where he caught another soldier, straining his right shoulder, for which he did not seek treatment at the time. He denied constant pain, although flare-ups occurred 2-3 times per week, lasting about 45 minutes. There were no signs of deformity, instability, giving way, locking, lack of endurance, effusion, dislocation or subluxation. There were no signs of inflammation. He did not require an assistive device. Range of motion was not limited. Upon x-ray, the examiner diagnosed degenerative changes of the acromioclavicular joint and possible mild rotator cuff impingement. The Board has reviewed the Veteran’s service treatment records and found no complaints of or treatment for a shoulder injury or condition. In fact, upon separation in 1992, the Veteran explicitly listed left shoulder pain, but did not mention the right shoulder. Nonetheless, the Veteran has self-reported the 1988 training incident. The examiner considered any possible nexus between the Veteran’s presently diagnosed degenerative changes and possible impingement and service and opined that the present disability is less likely than not related to his 1988 shoulder injury. Specifically, the examiner stated that the injury, as reported by the Veteran was a pulling type injury. However acromioclavicular joint and impingement injuries are compression type injuries. Therefore, they could not be etiologically connected. The Board finds the examiner’s opinion persuasive. It was rendered by a medical professional, in contemplation of the Veteran’s complete medical and reported history of injury, and relies upon known medical principles. The Board has searched the record for evidence which would contradict this opinion, but finds none. Therefore, the claim must be denied. The Board has also considered whether the degenerative changes to the Veteran’s shoulder, may be considered arthritis for purposes of presumptive service connection, but finds that the claim must be denied under this premise as well. Even presuming his shoulder does fall under the definition of arthritis, the evidence does not support a finding that it manifested to a compensable degree within a year of separation. The earliest medical evidence of a shoulder issue is dated in October 2008. Further, by his own admission, the Veteran has reported onset in 1999, seven years after separation. As such, the claim should be denied on a presumptive basis as well. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 3. Entitlement to service connection for deteriorated joints in the left hand The Veteran seeks service connection for deteriorated joints of the left hand. The Board finds the claim should be denied. As discussed above, the first criteria for service connection is a presently diagnosed chronic disability. The Veteran was afforded a peripheral nerve examination in October 2010. At that time, the left hand had normal monofilament sensation and sharp/dull discrimination. There was no report of pain on motion. Range of motion was complete. Hand grip and grasp strength was 5/5. In April 2011 a new examination was conducted. Range of motion was complete with no loss. There was no evidence of ankylosis. There was no evidence of pain, fatigue, weakness, lack of endurance, or incoordination in the left hand. No hand strength abnormalities were observed. No hand dexterity abnormalities were observed. There was no flexion deformity in either hand. The examiner stated that there was no pathology to render a diagnosis in either hand, and in his opinion, the hands were within normal limits. The Board has reviewed the Veteran’s available medical records but found no evidence of a presently diagnosed chronic disability in his left hand. Thus, the claim must be denied because the claim fails the first criteria for a grant of service connection, namely, a present disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 4. Entitlement to service connection for sleep apnea The Veteran seeks service connection for sleep apnea. The Board finds the claim should be denied. At the outset, the Veteran’s medical treatment records indicate a present diagnosis of sleep apnea. However, the Board finds that the claim fails the second criteria of service connection, namely, an in-service incident, injury or illness to which that disability may be linked. The Veteran’s service treatment records show no evidence of any sleep apnea or other sleep or breathing condition during service. The earliest evidence of sleep apnea in the medical record are dated many years after separation from active service (with evidence of a “questionable” history of sleep apnea noted in April 2005- 13 years after separation). The Board does take notice of a statement from the Veteran’s roommate attesting to sleep apnea symptoms since 2009. However, while a lay person is competent to report observable symptomatology, this evidence merely speaks to the present diagnosis, which is already conceded. The Veteran separated from service 17 years prior to the symptoms reported by his roommate. As such, this does not provide evidence of an in-service incident, injury or illness. In sum, because there is no evidence of any symptoms, complaints, treatment, or diagnosis of sleep apnea during service, nor any evidence of an injury or illness to which the present disability may be etiologically linked, the Board must deny the claim as having failed the second criteria of service connection. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 5. Entitlement to service connection for a heart condition The Veteran seeks service connection for a heart condition. The Board finds that the claim should be denied. At the outset, the Board concedes that the Veteran has a present heart condition, variously diagnosed as valve shrinkage, heart murmur, aortic valve stenosis, and coronary artery disease. However, despite his present diagnosis, the Board finds that the claim fails the second criteria of service connection- an in-service incident, illness or injury to which his present heart condition may be linked. A review of the Veteran’s service treatment records reveals no evidence of any heart condition or disability. He never complained of any heart-related symptoms. Upon separation in 1992, he explicitly denied any heart trouble, and none was noted by the physician who conducted the examination. The earliest evidence of a medical diagnosis of a heart condition occurred in April 2005, when he was noted to have a “questionable” history of heart murmur. This was approximately 13 years after separation. In sum, because there is no evidence of any symptoms, complaints, treatment, or diagnosis of a heart condition during service, nor any evidence of an injury or illness to which the present disability may be etiologically linked, the Board must deny the claim as having failed the second criteria of service connection. To the extent that the Veteran’s various heart conditions may fall under the definition of arteriosclerosis, the Board finds that presumptive service connection cannot be granted because there is no evidence that the condition manifested itself to a compensable degree within one year of separation from service. Finally, to the extent that the Veteran required a cardiac clearance prior to his undergoing surgery for his service-connected low back disability, the Board has reviewed the medical evidence of record but finds no evidence which would etiologically link those two disabilities together. Rather, they are separate etiologies, with the heart condition potentially affecting the Veteran’s ability to undergo surgery for an unrelated spinal disability. As such, there is no evidence to support a grant of service connection as secondary to his back disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 6. Entitlement to service connection for deteriorated joints in the right hand The Veteran seeks service connection for deteriorated joints of the right hand. The Board finds the claim should be denied The Veteran’s service treatment records indicate he sustained lacerations to the right hand in 1990. As discussed above, the first criteria for service connection is a presently diagnosed chronic disability. The Veteran was afforded a peripheral nerve examination in October 2010. At that time, the right hand had normal monofilament sensation and sharp/dull discrimination. There was no report of pain on motion. Range of motion was complete. Hand grip and grasp strength was 5/5. In April 2011 a new examination was conducted. Range of motion was complete with no loss. There was no evidence of ankylosis. There was no evidence of pain, fatigue, weakness, lack of endurance, or incoordination in the left hand. No hand strength abnormalities were observed. No hand dexterity abnormalities were observed. There was no flexion deformity in either hand. The examiner stated that there was no pathology to render a diagnosis in either hand, and in his opinion, the hands were within normal limits. The Board has reviewed the Veteran’s available medical records but found no evidence of a presently diagnosed chronic disability in his right hand. Thus, although is service treatment records do indicate an injury to the right hand during active service, the claim must be denied because the claim fails the first criteria for a grant of service connection, namely, a present disability to which that injury may be etiologically linked. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 7. Entitlement to service connection for foot fungus The Veteran seeks service connection for foot fungus, diagnosed as tinea pedis. The Board finds the claim should be denied. Although the Veteran has a present diagnosis of tinea pedis, the Board finds that the claim fails the second criteria of service connection – an in-service incident, illness or injury to which that disability may be linked. A review of the Veteran’s service treatment records does not show any treatment for a skin issue, particularly of the feet. Upon separation, the Veteran listed multiple acquired medical issues during his period in service. Although he did indicate “foot issues,” he then clarified that he was reporting a diagnosis of flat feet. He denied any skin diseases at that time. Likewise, there is no medical evidence of any skin condition of the feet until September 2011, when he was diagnosed by a private podiatrist with tinea pedis. The Veteran has provided photographic evidence of his tinea pedis, but that speaks to a present diagnosis, which is conceded. Those photos do not prove that he experienced any foot or skin condition during active service. In short, the Board finds that the claim must be denied because there is no evidence of a skin condition of the feet during active service to which the present diagnosis may be linked. Likewise, there is no medical evidence of such a condition from the time of service until the present. The earliest evidence of tinea pedis is in September 2011, approximately 19 years after he separated from service. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 8. Entitlement to service connection for headaches The Veteran seeks service connection for headaches. The Board finds that the claim should be denied. At the outset, the Board notes that the Veteran has a present diagnosis of headaches. A review of his service treatment records indicates that upon separation he reported headaches as a medical issue which arose during active service (headaches are not noted on his entrance examination). In light of the above, the Veteran was afforded a VA examination in April 2011 to assess the medical nature and etiology of his headaches. At that time the Veteran reported that he sustained a head injury when he was attacked in Thailand in 1990. He reported to the examiner that he began experiencing headaches thereafter, and that they resolved approximately two months later. He reported his headaches returning in about 2007. The examiner noted the Veteran’s complete medical history and the Veteran’s own reported history of headaches and opined against a medical nexus to the in-service head injury. Particularly, the examiner noted that the Veteran, himself, denied having headaches between 1990 and 2007, and the Veteran’s service treatment records which generally attributed his headaches during service to other pathologies such as pharyngitis or allergies. The Board finds this opinion to be persuasive as it was rendered by a physician, in contemplation of the Veteran’s complete medical history and his own reported history of symptoms, as well as known medical principles. The Board does not discount the Veteran’s own beliefs that his headaches are due to his in-service injury, however, by his own admission, his headaches did not occur between several months after that incident, and 2007, a period of approximately 17 years. As such, there is no history of chronicity. Further, while the generally known principle that a head injury may lead to headaches gives some credence to the Veteran’s opinion, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed.Cir.2010) (recognizing that in some cases lay testimony “falls short” in proving an issue that requires expert medical knowledge). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his hearing loss, especially considering the VA examiner’s conclusions to the contrary and the fact that the Veteran, himself, has denied a continuity of symptoms since service. See id. In sum, the Board finds that the Veteran’s headaches are less likely than not related to his in-service injury, as such, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102 (2017). 9. Entitlement to service connection for right arm numbness The Veteran seeks service connection for numbness of the right arm. The Board finds the claim should be denied. The Veteran has a present diagnosis of right arm, episodic numbness. The Veteran’s service treatment records do not show any complaints of or treatment for right arm numbness. Upon separation he denied any such complaints, particularly dealing with the right arm. There is no evidence of such numbness occurring within one year of separation from service. Rather, in his October 2010 VA examination, the Veteran reported that he first started experiencing numbness in 2000. The numbness itself was described as more vascular than neurological in origin and did not follow any nerve track. Considering this, because there is no evidence of any symptoms, complaints, treatment, or diagnosis of arm numbness during service, nor any evidence of an injury or illness to which the present diagnosis may be etiologically linked, the Board must deny the claim as having failed the second criteria of service connection. To the extent that the Veteran has asserted that his right arm numbness is secondary to his claimed right shoulder injury, as addressed above, the Board has denied service connection for that injury. As such, there is no underlying disability to which it may be connected for service connection purposes. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. Increased Ratings Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran’s entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where, as in the case of the issues on appeal, the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of staged ratings are required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Further, “[w]here 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 required for that rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7. 10. Entitlement to an initial rating in excess of 40 percent for low back strain The Veteran seeks a rating in excess of 40 percent for service-connected low back strain. Upon careful review, the Board finds the claim should be denied. For all periods on appeal, the Veteran’s low back strain is presently rated as 40 percent disabling under Diagnostic Code 5237, which compensates for lumbosacral strain, and applies the general rating formula for diseases and injuries of the spine. Under the applicable criteria, a 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237. 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 With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). Also, potentially applicable in this matter is Diagnostic Code 5243, which compensates for a back injury based on intervertebral disc syndrome (IVDS). Under that diagnostic criteria, a 40 percent rating is assigned for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks in the prior 12 months. A 60 percent rating is assigned for IVDS with incapacitating episodes having a total duration at least 6 weeks in the prior 12 months. 38 C.F.R. § 4.71a, DC 5243. While rating of spine disabilities does include consideration of any associated neurological symptoms, the below remand addresses the question of increased disability ratings for the Veteran’s associated neurological symptoms of the bilateral lower extremities. 38 C.F.R. § 4.71a, Note 1. As such, this opinion will defer on such symptoms until the ordered development has taken place. The Veteran was afforded a VA examination in October 2010, which shoed flexion to 90 degrees, extension to 10 degrees, and lateral flexion and rotation to 10 degrees on each side. There was no evidence of ankylosis found which would give rise to a higher rating under the general schedule, and he denied any incapacitating episodes or days lost from work which would afford a higher rating under the diagnosis of IVDS. As such, this examination does not give rise to a higher schedular rating. The Veteran was again afforded a VA examination in June 2014, at which time he was found to have forward flexion limited to 30 degrees with pain at 30 degrees. Extension was to 15 degrees with pain at 15 degrees. Lateral flexion and rotation were each to 10 degrees with pain at 10 degrees. There was no evidence of ankylosis or IVDS which would provide for a higher schedular rating. The Board has also searched the Veteran’s available treatment records and finds no evidence of ankylosis or IVDS which would give rise to a higher rating under the applicable diagnostic criteria. In short, the Veteran has already been granted the maximum rating for a low back disability based on limitation of motion, and absent any evidence of ankylosis or IVDS resulting n incapacitating episodes of 6 weeks or greater, the Board cannot assign a higher rating. Thus, the claim for an increased rating is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 11. Entitlement to an initial increased rating for bilateral pes planus, presently rated as noncompensable from August 29, 2009, and as 30 percent disabling from September 28, 2011 The Veteran is service-connected for bilateral pes planus, presently rated as noncompensable from August 29, 2009, and as 30 percent disabling from September 28, 2011. The Board finds that a 30 percent rating, but no greater, should be granted for all periods on appeal. At the outset, the Board notes that the increased rating, effective September 28, 2011, was granted in a July 2014 rating decision. Since that time, the RO has separately developed the issue of an earlier effective date for the increased rating grant, which was also certified to the Board at this time. As the July 2014 grant did not constitute a total grant of the issue on appeal, and the issue of the initial rating prior to September 2011 remained on appeal, those issues are the same and have been combined into one issue in this decision. Pes planus is rated under Diagnostic Code 5276, which grants a noncompensable rating for unilateral or bilateral flat foot with mild symptoms relieved by built-up shoe or arch support. A 10 percent rating is assigned for moderate unilateral or bilateral flat foot, described as the weight-bearing line over or medial to the great toe, inward bowing of the tendo-achillis, pain on manipulation and use of the feet. A 30 percent rating is assigned for bilateral severe flat foot, described as objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. Finally, a 50 percent rating is assigned for bilateral pronounced flat foot, described as marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo-achillis on manipulation, and not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. The Veteran was first afforded a VA examination in connection with his service connection claim in April 2011. At that time, the Veteran’s pes planus diagnosis was confirmed. The examiner stated that symptoms included swelling, pain, fatigability and cramps in the toes. The Veteran used orthotic inserts. He could stand 15-30 minutes and walk one quarter mile maximum. The examiner did not comment on pain on manipulation, evidence of deformity, or characteristic callosities. Nonetheless, the examination did suggest evidence of swelling on use and at rest, which is specifically noted as a criterion which would give rise to a 30 percent rating under the diagnostic criteria. As such, the Board will afford the Veteran the benefit of the doubt, and grant a 30 percent from the date of service connection. Private podiatry records dated in September 2011 indicate pes planus with pain and objective evidence of swelling and painful calluses of both feet, which supports a 30 percent rating under the diagnostic criteria. However, there is no evidence of the type of symptoms that would give rise to a higher rating such as marked pronation or extreme tenderness of the plantar surfaces, or severe spasm of the tendo-achillis. Thus, a rating in excess of 30 percent is not supported. Finally, in June 2014, the Veteran was again afforded a VA examination. He reported intermittent pain and throbbing, daily. Pain was noted on both sides upon manipulation accentuated. Although swelling was not found on use, he did have characteristic callosities. He used orthotics and a cane. He did have evidence of inward bowing of the tendo-achillis, but there was no evidence of marked deformity or marked pronation. The examiner stated that his condition did not impact his ability to perform any type of occupational task. In short, this examination supports a continued rating of 30 percent, based on the symptoms described in the diagnostic code, but no higher. There is no evidence of pronounced flat foot such as marked pronation, extreme tenderness of the plantar surfaces, marked inward displacement and severe spasm of the tendo-achillis on manipulation or non-improvement with use of orthotics. As such, the Board cannot grant a higher rating based on the diagnostic criteria. The Board has carefully reviewed the Veteran’s other available treatment records, but finds none that would document the type of symptoms which would give rise to a rating higher than 30 percent for any period on appeal. As such, the Board will grant the Veteran a 30 percent rating prior to September 28, 2011, but denies a rating in excess of 30 percent thereafter. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. Earlier Effective Date Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. A claim is a written communication “requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit.” See 38 C.F.R. § 3.1(p). The intent to apply for benefits is essential to any claim and therefore, absent intent, no claim for entitlement exists. Criswell v. Nicholson, 20 Vet. App. 501, 503 (2006); see MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have intent to file a claim for VA benefits). Thus, a claim, either formal or informal, must be in writing in order for it to be considered a “claim” for benefits within the meaning of the law. See Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999). A complete claim is required for all types of claims, and will generally be considered filed as of the date it was received by VA. 38 C.F.R. §3.155(d). A claim may be filed by either the Veteran, or his duly appointed representative. 38 C.F.R. §3.155(a-b). A claimant may indicate a desire to file a claim for benefits by filing an intent to file a claim to VA. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by VA. If VA receives a complete application form within one year of the receipt of the intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. §3.155(b). 12. Entitlement to an earlier effective date for the grant of service connection of right lower extremity radiculopathy The Veteran was granted service connection for right lower extremity radiculopathy in a July 2014 rating decision, granted as secondary to his service-connected low back strain. The Board finds that the claim should be denied. The Veteran never formally filed a claim of service connection for right lower extremity radiculopathy. Rather, the claim was granted as secondary to his service-connected low back disability under 38 C.F.R. § 4.71a, Note 1, which provides for separate ratings for neurological symptoms of a spine disability. Nonetheless, to the extent that the claim of service connection for a low back disability implied a claim for any neurological symptoms, the date of the claims is August 28, 2009. As stated above, the date of service connection will be the date of the claim, or the date entitlement arose, whichever is later. The primary criteria for establishing entitlement to service connection is a present diagnosis of a disability. Therefore, absent a diagnosis, entitlement cannot arise. The Board has searched the record and finds that the first evidence of right lower extremity radiculopathy is in the June 17, 2014, VA examination report. This occurred later than the date of the claim, and therefore is the appropriate date for the grant of service connection. As such, the claim is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102 (2017). REASONS FOR REMAND As an initial matter, multiple issues below are remanded under the holding in Manlincon v. West, 12 Vet. App. 238 (1999). In April 2018, the Veteran’s representative submitted a statement indicating that an April 2014 notice of disagreement was also filed with regard to the issues of increased ratings for major depressive disorder, tinnitus, and right ear hearing loss. The Board has reviewed the claims file but found no such notice of disagreement. As such, it will not take jurisdiction over those issues at this time for the purpose of remanding for a statement of the case. 13. Entitlement to service connection for TBI is remanded. The Veteran’s claim of service connection for a TBI was denied in an April 2014 rating decision. In August 2014, he submitted a notice of disagreement with that denial. To date a statement of the case has yet to be issued. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 14. Entitlement to service connection for a left shoulder injury is remanded. As discussed above, the Board has reopened the previously denied and final claim of service connection for a left shoulder injury. The Board cannot make a fully-informed decision on the issue of because no VA examiner has opined whether the left shoulder symptoms constitute a present chronic disability, or if that disability, if it exists, can be linked to any incident of active service. Thus, a remand is necessary.   15. Entitlement to service connection for left arm numbness is remanded. Because a decision on the remanded issue of service connection for a left shoulder injury could significantly impact a decision on the issue of service connection for left arm numbness, the issues are inextricably intertwined. A remand of the claim for an examination is required. 16. Entitlement to service connection of PTSD is remanded. The Veteran’s claim of service connection for PTSD was denied in an April 2014 rating decision. In August 2014, he submitted a notice of disagreement with that denial. To date a statement of the case has yet to be issued. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 17. Entitlement to an initial compensable rating for left knee strain is remanded. The Veteran’s claim of service connection for a left knee strain was granted in an April 2014 rating decision and a noncompensable rating was assigned. In August 2014, he submitted a notice of disagreement with that rating. To date a statement of the case has yet to be issued. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 18. Entitlement to an initial compensable rating for right knee strain is remanded. The Veteran’s claim of service connection for a left knee strain was granted in an April 2014 rating decision and a noncompensable rating was assigned. In August 2014, he submitted a notice of disagreement with that rating. To date a statement of the case has yet to be issued. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 19. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is remanded. 20. The Veteran’s claim of service connection for left lower extremity radiculopathy was granted in an April 2014 rating decision and a 10 percent rating was assigned. In August 2014, he submitted a notice of disagreement with that rating. To date a statement of the case has yet to be issued. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 21. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is remanded. The Veteran’s claim of service connection for right lower extremity radiculopathy was granted in a July 2014 rating decision and a 10 percent rating was assigned. In August 2014, he submitted a notice of disagreement with that rating. While the RO adjudicated the issue of entitlement to an earlier effective date for that grant of service connection, as addressed in the decision above, to date a statement of the case has yet to be issued regarding the increased rating claim. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 22. Entitlement to an earlier effective date for the grant of service connection for left lower extremity radiculopathy is remanded. The Veteran’s claim of service connection for left lower extremity radiculopathy was granted in an April 2014 rating decision and a 10 percent rating was assigned. In August 2014, he submitted a notice of disagreement with the effective date of that grant of service connection. To date a statement of the case has yet to be issued regarding the effective date of that grant. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999).   23. Entitlement to an earlier effective date for the grant of total disability based on individual unemployability (TDIU) is remanded. The Veteran was granted TDIU effective July 5, 2011, in a July 2014 rating decision. In August 2014, he submitted a notice of disagreement with the effective date of that grant of TDIU. To date a statement of the case has yet to be issued regarding the effective date of that grant. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). The matters are REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses the issues of an earlier effective date for the grant of service connection for left lower extremity radiculopathy; an earlier effective date for the grant of TDIU; an increased rating for left lower extremity radiculopathy; an increased rating for right lower extremity radiculopathy; an increased rating for left knee strain; and increased rating for right knee strain; service connection of PTSD; and service connection of a TBI. Only if the Veteran perfects an appeal by submitting a timely VA Form 9 should the issues be returned to the Board for further appellate consideration. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left shoulder disability and numbness of the left arm. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or illness, to include the Veteran’s reported in-service assault. 3. Thereafter, readjudicate the claims remaining on appeal considering all evidence of record. If the benefit sought should remain denied or not be granted in full, issue the Veteran and his representative a supplemental statement of the case and afford adequate time to respond before returning the matter to the Board for further appellate review. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Pryce, Associate Counsel