Citation Nr: 18129477 Decision Date: 08/27/18 Archive Date: 08/24/18 DOCKET NO. 15-31 237 DATE: August 27, 2018 ORDER Entitlement to an initial rating higher than 10 percent from September 24, 1999, to April 2, 2002, for coronary artery disease (CAD) status post myocardial infarction (MI) is denied. Entitlement to a rating of 60 percent from April 2, 2002, for CAD status post MI is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to a rating higher than 60 percent from April 2, 2002, for CAD status post MI is denied. Entitlement to an initial compensable rating for scar, residuals of coronary artery bypass graft (CABG) associated with CAD status post MI is denied. Entitlement to a date earlier than September 24, 1999, for service connection for CAD status post MI is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) from April 3, 2002, is granted, subject to controlling regulations governing the payment of monetary awards. FINDINGS OF FACT 1. Prior to April 2, 2002, the Veteran’s CAD was characterized by metabolic equivalent of tasks (METS) level greater than 7, without evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or x-ray. 2. From April 2, 2002, the Veteran’s CAD was characterized by a workload of greater than 3 METS but not greater than 5 METS resulting in in dyspnea, fatigue, angina, dizziness, or syncope; without chronic congestive heart failure or a left ventricular dysfunction with ejection fraction (LVEF) of 30 to 50 percent. 3. The Veteran’s scar, residuals of CABG associated with CAD status post MI, is not painful or unstable. 4. A September 2011 RO decision awarded service connection for CAD status post MI effective September 24, 1999, as a disease presumptively related to herbicide agent exposure. 5. The evidence reflects that the Veteran did not file a service connection claim for heart disease prior to September 24, 1999. 6. The evidence is at least evenly balanced as to whether the Veteran’s service-connected disabilities are of such nature and severity as to prevent him from securing or following substantially gainful employment from April 3, 2002. CONCLUSIONS OF LAW 1. From April 1, 2000, to April 2, 2002, the criteria for an initial rating in excess of 10 percent for CAD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.104, Diagnostic Code (DC) 7006-7017. 2. From to April 2, 2002, the criteria for a rating of 60 percent, but not higher, for CAD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.104, DC 7006-7017. 3. The criteria for an initial compensable rating for scar, residuals of CABG, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.118, DC 7804. 4. The criteria for entitlement to an effective date prior to September 24, 1999, for the award of service connection for CAD status post MI have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400, 3.816. 5. With reasonable doubt resolved in favor of the Veteran, the criteria for a TDIU due to service-connected disabilities, from April 3, 2002, have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1965 to December 1968. This matter comes before the Board of Veterans’ Appeals on appeal from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the September 2011 rating decision, the RO granted service connection for CAD and assigned staged ratings of 100 percent, effective September 24, 1999; 10 percent, effective April 1, 2000; and 60 percent effective October 11, 2002. The RO also awarded service connection for a scar, residual of CABG, rated as noncompensable effective December 27, 1999; and a TDIU, effective February 19, 2003. The Veteran timely appealed the assigned ratings and effective date for the grant of service connection for CAD, assigned rating for the scar, and effective date for the grant of a TDIU. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a “staged rating” (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). If two ratings are potentially applicable, the higher rating 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. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to an initial rating higher than 10 percent prior to April 2, 2002, and in excess of 60% from April 2, 2002 for CAD status post MI The Veteran is currently service-connected for CAD rated as 100 percent disabling from September 24, 1999, to April 1, 2000; 10 percent disabling from April 1, 2000, to October 11, 2002; and 60 percent disabling thereafter, under 38 C.F.R. § 4.104, DCs 7006-7017. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. The additional code is shown after a hyphen. As such, the Veteran’s CAD was rated under DC 7017 based on coronary bypass surgery. This DC provides for a 10 percent rating for a workload greater than 7 METS but not greater than 10 METS resulting in dyspnea, fatigue, angina, dizziness, or syncope; or where continuous medication required. A 30 percent evaluation is warranted for a workload of greater than 5 METS but not greater than 7 METS resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or x-ray. A 60 percent evaluation is warranted for more than one episode of acute congestive heart failure in the past year, or a workload of greater than 3 METS but not greater than 5 METS resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure, or when a workload of 3 METS or less results in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, DC 7006-7017. A note prior to the Diagnostic Code explains that one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METS at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METS by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METS and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). VA revised the regulation that pertains to the evaluation of specified cardiovascular disorders; those rated under DCs 7000 through 7007, 7011, and 7015 through 7020 effective from October 6, 2006. See 38 C.F.R. § 4.104. The revised regulation did not alter the rating criteria under DC 7005 as outlined above; however, it contains the following new provisions: (1) in all cases, whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or x-ray) is present and whether or not there is a need for continuous medication must be ascertained; (2) even if the requirement for a 10 percent rating (based on the need for continuous medication) or a 30 percent rating (based on the presence of cardiac hypertrophy or dilatation) is met, MET testing is required except when there is a medical contraindication; when the left ventricular ejection fraction has been measured and is 50 percent or less; when chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year; and when a 100 percent evaluation can be assigned on another basis; (3) if left ventricular ejection fraction (LVEF) testing is not of record, evaluation should be based on alternative criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran’s cardiovascular disability. VA treatment records in September 1999 reflect METS of 8.8, and the Veteran denied dizziness, shortness of breath, chest pain, nausea, or vomiting. An October 1999 chest computed tomography (CT) scan indicated no congestive heart failure (CHF). In December 1999, the Veteran reported chest pain brought on by exertion, usually elicited by walking 200 yards, climbing two flights of stairs, or taking a shower. In March 2001, he reported decreased exercise tolerance and extreme shortness of breath, but no chest pain, walking from his car to work. A September 2001 stress test reflected METS of 9.1, and that the test was stopped due to chest pain and dyspnea. A Social Security Administration (SSA) case assessment documents METS of 5. VA treatment records in April 2002 reflect LVEF of 71 percent, and an October 2002 exercise test indicated METS of 4 to 5. In January 2004, the Veteran had LVEF of 50 percent with occasional diaphoresis, shortness of breath, lightheadedness, nausea, and chest pain. In November 2004, the Veteran had LVEF of 70 percent, and a September 2005 electrocardiogram (EKG) reflected no CHF. In November 2006, the Veteran had LVEF of 60 percent. In December 2008, the Veteran reported dyspnea while mowing the lawn or walking up two flights of stairs. He also had chest discomfort during intercourse during the past few months, and in the last week he experienced chest pressure that waxed and waned when he stepped out of the shower. An echocardiogram reflected LVEF of 60 to 65 percent. A March 2009 diabetes VA examination indicates no evidence of any current chest pain, shortness of breath, orthopnea, paroxysmal nocturna dyspnea, or pedal edema. There were no irregularities or palpations of the heart, and no CHF or atrial fibrillation. VA treatment records reflect LVEF of 57 percent in January 2010, LVEF of 69 percent in December 2012, and LVEF of 52 percent in February 2015. Additional records in February 2015 indicated no chest pain, dyspnea with exertion, orthopnea, or paroxysmal nocturna dyspnea. The Veteran had been doing well with no complaints, and he had an LVEF of 67 percent. An April 2015 VA examination report reflects that the Veteran required continuous medication for his heart condition. The examiner noted that the Veteran had a MI in 1999; but that he had no CHF, cardiac arrhythmia, heart valve condition, infectious heart conditions, or pericardial adhesions. There was evidence of cardiac hypertrophy based on a March 2015 echocardiogram, and he had LVEF of 67 percent. A stress test was not performed due to the Veteran’s chronic obstructive pulmonary disease (COPD) and his status post CABG. Instead, the examiner conducted an interview-based METS test and found that the Veteran had METS between 5 and 7 with dyspnea, angina, and slight burning sensation in chest. The METS were estimated per the LVEF of 67 percent and based on the current LVEF of 52 percent. Based on the evidence of record, the Board finds that a rating in excess of 10 percent from April 1, 2000, to April 2, 2002, is not warranted. Further, the Board finds that a rating of 60 percent, but not higher, from April 2, 2002, is warranted. Prior to April 2, 2002, the evidence of record does not demonstrate symptoms more nearly approximating episodes of METS greater than 5 but not greater than 7 resulting in dyspnea, fatigue, angina, dizziness, or syncope; and cardio hypertrophy or dilation on an electrocardiogram, echocardiogram or x-ray. There is also no evidence that the symptoms more nearly approximated CHF, METS from 3 to 5, METS less than 3 or an ejection fraction less than 30 percent. To the contrary, the Veteran’s METS levels were 8.8 in September 1999 and 9.1 in September 2001; he did not experience any dizziness, angina, fatigue, syncope, or dyspnea; and his EKG showed normal sinus rhythm. These findings are indicative of a disability rating of 10 percent. From April 2, 2002, the Veteran’s CAD warrants a rating of 60 percent, but not higher. The evidence of record reflects METS greater than 3 but no greater than 5 in April 2002 and October 2002. However, the Veteran does not demonstrate symptoms more nearly approximating episodes of 3 METS or less, chronic CHF, or LVEF of less than 30 percent. To the contrary, from April 2, 2002, the Veteran’s LVEF ranged between 71 and 52 percent. Likewise, there is no evidence of CHF, and the April 2015 VA examination estimated METS to be greater than 5 but no greater than 7. The Board finds the VA examination regarding the manifestations of the Veteran’s CAD to be persuasive and probative against the claim for higher initial ratings because it was based on a review of the claims file and supported by a medical explanation that is consistent with the record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value to a medical opinion). The Board acknowledges the Veteran’s statements that his CAD warrants a rating in excess of 60 percent. The Board notes that the Veteran is competent to report that he has difficulty breathing and other symptoms. Given, however, that the applicable diagnostic codes require specific measurements of the METS, LVEF, and diagnosis of acute or chronic CHF, the Veteran’s statements are not competent with regard to whether he has met the criteria for these higher ratings. Cf. Petitti v. McDonald, 27 Vet. App. 415, 427 (2015) (a regulation that “does not speak to the type of evidence required... certainly does not, by its own terms, restrict evidence to ‘objective’ evidence”). See also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (lay evidence is not always competent evidence of a diagnosis or nexus-particularly where complex medical questions or the interpretation of objective medical tests are involved). The Board has considered the Veteran’s claim and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette, 28 Vet. App. at 369-70 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). For the reasons discussed above, the preponderance of the evidence is against an initial rating in excess of 10 percent for the Veteran’s CAD from April 1, 2000, to April 2, 2002. However, a rating of 60 percent, but no higher, is warranted from April 2, 2002, under DC 7006-7017. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. 2. Entitlement to an initial compensable rating for scar, residuals of CABG associated with CAD status post MI The Veteran is currently rated as noncompensable for a scar, residuals of CABG associated with CAD status post MI, pursuant to 38 C.F.R. § 4.118, DC 7804. DC 7804 provides a 10 percent evaluation for one or two scars that are unstable and painful on examination. A 20 percent evaluation applies to three or four scars that are unstable or painful. A 30 percent evaluation is for five or more scars that are unstable or painful. Note (1) to DC 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC when applicable. 38 C.F.R. § 4.118. VA treatment records in January 2000 reflect a sternotomy scar with no evidence of inflammation, infection, or erythema. Records in May 2000 document a well-healed sternal incision, soft and nontender. An April 2015 VA heart examination reflects a scar that was not painful and/or unstable, with a total area not greater than 39 square cm. Based on the evidence of record, the Board finds that a compensable rating for a scar, residuals of CABG, is not warranted. Here, the Veteran’s scar, residuals of CABG, was described as well-healed, soft, and nontender in May 2000. Further in April 2015, the VA examiner noted that the scar was not painful or unstable. Under DC 7804, a compensable rating is warranted for one or two scars that are painful or unstable. As the evidence reflects that the Veteran’s scar is neither, a compensable rating under DC 7804 is not warranted. The Board has considered the Veteran’s claim and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette, 28 Vet. App. at 369-70 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). For all for the foregoing reasons, the Board finds that there is no basis for staged rating of the Veteran’s scar, residuals of CABG, and that the claim for a compensable rating must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine, but finds that the preponderance of the evidence is against assignment of a compensable rating for the Veteran’s scar, residuals of CABG, at any point pertinent to the claim for initial rating. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Effective Date 3. Entitlement to a date earlier than February 24, 1999, for service connection for CAD status post MI Generally, except as otherwise provided, the effective date of an award of compensation based on an original claim will be the day following separation from active service or the date entitlement arose, if the claim is received within one year after separation from service; otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Where compensation is awarded pursuant to a liberalizing law or a liberalizing VA issue, the effective date of the increased shall be fixed in accordance with facts found, but shall not be earlier than the effective date of the act or administrative issue. 38 U.S.C. § 5110 (g); 38 C.F.R. § 3.114 (a). If a claim is reviewed on the initiative of VA within one year from the effective date of the law or VA issue, or at the request of a claimant received within one year from that date, benefits may be authorized from the effective date of the law or VA issue. 38 C.F.R. § 3.114 (a)(1). However, if a claim is reviewed on the initiative of VA more than one year after the effective date of the law or VA issue, benefits may be authorized for a period of one year prior to the date of administrative determination of entitlement. 38 C.F.R. § 3.114 (a)(2). Finally, if a claim is reviewed at the request of the claimant more than one year after the effective date of the law or VA issue, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114 (a)(3). In order to be eligible for a retroactive award, the claimant must show that all eligibility criteria for the benefits existed at the time of the effective date of the law or administrative issue and continuously thereafter. 38 C.F.R. § 3.114 (a). Ordinarily, under the above provisions for liberalizing laws, awards based on presumptive service connection established under the Agent Orange Act of 1991 can be made effective no earlier than the date VA issued the regulation authorizing the presumption. Presumptive service connection for ischemic heart disease (IHD), which includes CAD, was initially established effective August 31, 2010. See 75 Fed. Reg. 53,202-53,216 (Aug. 31, 2010). Nevertheless, with respect to earlier effective date claims for service connection for diseases presumed to be caused by herbicide or Agent Orange exposure, VA has promulgated special rules to implement orders of a United States District Court in the class action of Nehmer v. United States Department of Veteran’s Affairs. See 38 C.F.R. § 3.816; Nehmer v. U.S. Veterans Admin., 32 F. Supp. 1404 (N.D. Cal. 1989); Nehmer v. U.S. Veterans Admin., 32 F. Supp. 2d 1175 (N.D. Cal 1999); Nehmer v. Veterans Admin. of the Gov’t of the U. S., 284 F.3d 1158 (9th Cir. 2002); Nehmer v. U.S. Veterans Admin., 494 F.3d. 846 (2007). The Nehmer litigation has created an exception to the generally applicable effective date rules contained in 38 U.S.C. § 5110 (g) and 38 C.F.R. § 3.114. In pertinent part, a Nehmer class member is defined as a Vietnam veteran who has a covered herbicide disease. 38 C.F.R. § 3.816 (b)(1)(i). A covered herbicide disease includes a disease for which the Secretary of Veterans Affairs has established a presumption of service connection pursuant to the Agent Orange Act of 1991. 38 C.F.R. § 3.816 (b)(2). Presumptive service connection for CAD was established effective August 31, 2010. See 75 Fed. Reg. 53,202-53,216 (Aug. 31, 2010). The Nehmer regulations provides for situations where the effective date can be earlier than the date of the liberalizing law, assuming a Nehmer class member has been granted compensation for a covered herbicide disease. Either (1) VA denied compensation for the same covered herbicide disease in a decision issued between September 25, 1985, and May 3, 1989; or (2) the class member’s claim for disability compensation for the covered herbicide disease was either pending before VA on May 3, 1989, or was received by VA between May 3, 1989, and the effective date of the statute or regulations establishing a presumption of service connection for the covered disease (here August 31, 2010). In these situations, the effective date of the award will be the later of the date such claim was received by VA or the date the disability arose, unless a claim was filed within one year of service discharge. 38 C.F.R. § 3.816 (c)(1), (c)(2), (c)(3). If neither circumstance exists, the effective date of the award of service connection shall be determined in accordance with either 38 C.F.R. § 3.114 or § 3.400. See 38 C.F.R. § 3.816 (c)(4). In its September 2011 rating decision, the RO noted that the Veteran filed a statement in support of the claim on September 24, 1999, in which the Veteran requested service connection for a heart condition secondary to a service-connected right knee disability. As a result of this claim, the RO received evidence showing a September 13, 1999, diagnosis of an acute myocardial infarction. The RO noted that CAD was recently added to the list of disabilities recognized as being related to herbicide exposure. As such, service connection for CAD was granted on a presumptive basis effective from September 24, 1999, the date the RO received the Veteran’s claim for a heart condition and the associated evidence showing a diagnosis of acute myocardial infarction. Review of the claim file revealed December 1973, December 1989, and October 1995, application for right knee increased rating; an October 1995 application for chemical addiction; an April 1998 application for service connection for a right knee scar; a June 1998 application for service connection for tinnitus, sinusitis, right knee arthritis, as well as increased rating for posttraumatic stress disorder (PTSD) and bilateral hearing loss; and an April 1999 application for compensation for left knee and hypertension. While the Veteran had contact with VA prior to his September 24, 1999, claim for a heart condition, there is no document in the evidence of record from which it could be inferred that the Veteran sought to file a claim for service connection for CAD or a heart condition prior to that date. 38 C.F.R. § 3.155 (a) (as in effect prior to March 24, 2015) (defining an informal claim as “[a]ny communication or action, indicating an intention to apply for one or more benefits.... Such informal claim must identify the benefit sought”); Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009) (the essential elements of a claim are “(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing”). See also 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 an intent to file a claim for VA benefits); Rodriguez v. West, 189 F.3d 1351, 1354 (Fed.Cir.1999) (noting that even an informal claim must be in writing). As noted above, VA added IHD, including CAD, to the disabilities listed in 38 C.F.R. § 3.309 (e) that are presumptively related to herbicide exposure effective August 31, 2010. 75 Fed. Reg. 53,202-53,216 (Aug. 31, 2010). The Veteran did not file a claim for service connection for CAD or a heart condition prior to September 24, 1999. The September 1999 claim was received by VA between May 3, 1989 and the effective date of the regulation establishing the presumption of service connection for CAD. The effective date of the award in this case is thus the later of the date the claim was received and the date disability arose. As the later of those dates in this case is September 24, 1999, an effective date prior September 24, 1999, for service connection for CAD is not warranted as a matter of law. The benefit of the doubt doctrine is therefore not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 4. Entitlement to a date earlier than February 19, 2003, for total disability rating based on individual unemployability based on service-connected disabilities (TDIU) The RO awarded a TDIU effective February 19, 2003, the date of a VA examination that found that the Veteran could not work due to his CAD. However, the Veteran contends TDIU should be granted as of April 3, 2002, the day after he stopped working full-time. Total disability will be considered to exist when there is present any impairment of mind or body, which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that he has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. 38 C.F.R. § 4.16(a). Further, 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 (West 2014); 38 C.F.R. § 3.400. That is, the effective date of an award “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” 38 U.S.C. § 5110 (a). However, in a claim for increased compensation, the effective date may date back as much as one year before the date of the application for increase if it is factually “ascertainable that an increase in disability had occurred” within that timeframe. 38 U.S.C. § 5110 (b)(3) (formerly (b)(2)); 38 C.F.R. § 3.400 (o)(2); see Gaston v. Shinseki, 605 F.3d 979, 982-83 (Fed. Cir. 2010) (“It is clear from the plain language of [section] 5110(b)(2) (now (b)(3)) that it only permits an earlier effective date for increased disability compensation if that disability increased during the one-year period before the filing of the claim”); Hazan v. Gober, 10 Vet. App. 511, 519 (1997) (stating that an “increase” for this purpose is one to the next disability level); VAOPGCPREC 12-98 (Sept. 23, 1998). The Board notes that TDIU claims are treated as increased rating claims for the purpose of determining the effective date of the TDIU. Based on the Board’s decision herein, the Veteran is service-connected for CAD (rated as 100 percent disabling from September 24, 1999; 10 disabling percent from April 1, 2000; and 60 percent disabling from April 2, 2002); partial patellectomy of the right knee with chondromalacia (rated as 10 percent disabling from July 1, 1994; and 20 percent disabling from June 11, 1998); PTSD (rated as 30 percent disabling from September 18, 2001); diabetes mellitus (rated as 10 percent disabling from September 15, 2008; and 20 percent disabling from June 1, 2009); right knee scar (rated as 10 percent disabling from November 2, 1995); right knee osteoarthritis (rated as 10 percent disabling from July 1, 1997); left knee osteoarthritis (rated as 10 percent disabling from April 9, 1999); and scar, residual of CAB (rated as noncompensable from December 27, 1999). The combined disability ratings are as follows: 20 percent, effective July 1, 1994; 30 percent, effective November 2, 1995; 40 percent, effective July 1, 1997; 50 percent, effective April 9, 1999; 100 percent effective September 24, 1999; 70 percent, effective April 1, 2000; and 90 percent, effective April 2, 2002. See 38 C.F.R. §§ 4.16(a), 4.25. Accordingly, the Veteran meets the schedular percentage requirements for entitlement to a TDIU from April 2, 2002. See 38 C.F.R. § 4.16(a). Nonetheless, the Board must also determine whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of these service-connected disabilities. Specifically, the Board must evaluate whether there are circumstances in the Veteran’s case, apart from any nonservice-connected condition and advancing age, which would justify a total rating based upon individual unemployability, due solely to his service-connected disabilities. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The crucial inquiry for the Board is not whether the Veteran is able to pursue his profession of choice, or indeed any particular job. Instead, the Board must inquire as to whether the Veteran can secure and follow a substantially gainful occupation in a more general sense. See Van Hoose, 4 Vet. App. at 363. The fact that a veteran is unemployed is not enough. It must be determined that his service-connected disorders without regard to his advancing age make him incapable of performing the acts required by employment. Id. A February 2003 VA Form 21-8940, Application for Increased Compensation Based on Unemployability, reflects that the last day the Veteran worked full-time was April 2, 2002; and that he became too disabled to work in April 2, 2002, due to his service-connected bilateral knees and PTSD. A February 2003 VA psychiatric examination reflects that the Veteran had to stop working due to his cardiac and other physical problems. A September 2008 VA knee examination indicated that the primary reason the Veteran could not work was because of his bilateral knees, as they would hinder him when driving and getting in and out of his vehicle. Further, an April 2015 VA heart examination documented that the Veteran was retired since 2002 due to MI and was discharged from his USPS position as a driver due to his medical condition of MI, as he could not pass his physical examination. In light of the above, the Board finds that the evidence is approximately evenly balanced as to whether the Veteran’s service-connected disabilities render him unable to secure and follow gainful employment from April 3, 2002, the date after he stopped working full-time. Here, the Veteran filed his claim for a TDIU in February 2003. In this case, it is factually “ascertainable that an increase in disability had occurred” within the one-year period prior to the date the Veteran applied for a TDIU. Specifically, the evidence shows that the Veteran’s last day of full-time employment was on April 2, 2002, and that he stopped working due to his service-connected CAD and bilateral knee disability. See 38 U.S.C. § 5110 (b)(3) (formerly (b)(2)); 38 C.F.R. § 3.400 (o)(2). For the foregoing reasons, a TDIU is warranted from April 3, 2002, the day after the Veteran last worked full time. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Leifert, Associate Counsel