Citation Nr: 19141014 Decision Date: 05/28/19 Archive Date: 05/28/19 DOCKET NO. 10-43 064 DATE: May 28, 2019 ORDER Entitlement to an effective date prior to March 11, 2008, for the grant of service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to service connection for psoriatic arthritis, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is denied. Entitlement to service connection for psoriasis, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is denied. Entitlement to an initial evaluation in excess of 20 percent for peripheral neuropathy of the left lower extremity is denied. Entitlement to an initial evaluation in excess of 30 percent for mood disorder with depression due to a general medical condition is denied. REMANDED Entitlement to service connection for cervical spine disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. Entitlement to an evaluation in excess of 40 percent for degenerative disc disease of the lumbar spine (with the exception of a period of a temporary total convalescence rating pursuant to 38 C.F.R. § 4.30) is remanded. Entitlement to a total rating based on individual employability due to service-connected disabilities (TDIU) prior to November 22, 2010 is remanded. Entitlement to an effective date prior to November 22, 2010, for the grant of basic eligibility for Dependents’ Educational Assistance (DEA) under Chapter 35 is remanded. FINDINGS OF FACT 1. On March 11, 2008, VA received the Veteran’s original claim for service connection for left leg disability, granted as peripheral neuropathy of the left lower extremity; however, prior to March 11, 2008, a July 13, 2007 Board decision implicitly denied the claim for peripheral neuropathy of the left lower extremity, and a diagnosis of peripheral neuropathy of the left lower extremity was not factually ascertainable within the period preceding the date of the March 11, 2008 claim, specifically from July 13, 2007. 2. The preponderance of the evidence is against finding that the Veteran’s psoriatic arthritis manifested to a compensable degree within the applicable presumptive period following service, that it had continuity of symptomatology since service, or that it is otherwise etiologically related to an in-service injury, event, or disease; or that it is proximately due to or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. 3. The preponderance of the evidence is against finding that the Veteran’s psoriasis is etiologically related to an in-service injury or disease, or that it is proximately due to or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. 4. Throughout the rating period, the most probative evidence of record demonstrates, the Veteran’s peripheral neuropathy of the left lower extremity, at worst, most closely approximates moderate incomplete nerve paralysis. 5. Throughout the rating period, the most probative evidence of record demonstrates the severity, frequency, and duration of the Veteran’s symptoms for his mood disorder with depression are productive of functional impairment that most closely approximate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to March 11, 2008 for the grant of service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400, 3.816. 2. The criteria for service connection for psoriatic arthritis due to service, or as proximately due to or chronically aggravated by service-connected degenerative disc disease of the lumbar spine, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for psoriasis due to service, or as proximately due to or chronically aggravated by service-connected degenerative disc disease of the lumbar spine, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for an initial disability rating in excess of 20 percent for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.124a, Diagnostic Code 8520. 5. The criteria for an initial disability rating in excess of 30 percent for mood disorder with depression have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1965 to July 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal from April 2009, December 2011, July 2015 and December 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The April 2009 rating decision, in part, continued a 40 percent evaluation for degenerative disc disease of the lumbar spine, denied service connection for a cervical spine disability, denied service connection for psoriatic arthritis, and denied entitlement to a TDIU. The December 2011 rating decision, in part, granted service connection for mood disorder with depression due to a general medical condition and assigned a 30 percent initial evaluation, effective from November 22, 2010. The July 2015 rating decision awarded entitlement to a TDIU and established basic eligibility for DEA, both effective from November 22, 2010. The December 2017 rating decision granted service connection for peripheral neuropathy of the left lower extremity and assigned an evaluation of 20 percent effective March 11, 2008. During the pendency of the appeal for an increased rating for degenerative disc disease of the lumbar spine, an April 2015 rating decision granted a temporary total convalescence rating pursuant to 38 C.F.R. § 4.30 for degenerative disc disease of the lumbar spine, effective from January 7, 2015 through April 30, 2015, based on surgical or other treatment necessitating convalescence. Because this increased evaluation does not represent a grant of the maximum benefits allowable under the VA Schedule for Rating Disabilities, the Veteran’s claim remains in appellate status. AB v. Brown, 6 Vet. App. 35, 38 (1993) (holding that a grant of a higher rating during the course of an appeal, but less than the maximum benefits allowable, does not abrogate the appeal). As noted above, entitlement to a TDIU was awarded in the July 2015 rating decision effective from November 22, 2010. During the pendency of the Veteran’s appeal for an increased evaluation for his lumbar spine disability, received by VA on March 11, 2008, the Veteran asserted that his service-connected lumbar disability, along with other disabilities, rendered him unemployable. Thus, entitlement to a TDIU is considered to be a component of his claim for an increased evaluation for his lumbar spine disability. Rice v. Shinseki, 22 Vet. App. 447 (2009). As such, entitlement to a TDIU at any time during the rating period from March 10, 2007 to November 22, 2010 remains for appellate consideration. In the present case, the Board concludes that bifurcating the Veteran’s claim previously characterized as entitlement to service connection for psoriatic arthritis, claimed as psoriatic arthritis and psoriasis, to include as secondary to service-connected degenerative disc disease of the lumbar spine, into two separate issues for independent adjudication is the proper way of handling the appeal. Specifically, the Board is bifurcating this issue into two separate issues - (1) service connection for psoriatic arthritis and (2) service connection for psoriasis, as set forth on the title page. The Board can bifurcate a claim and address different theories or arguments in separate decisions. Roebuck v. Nicholson, 20 Vet. App. 307, 315 (2006); see also Locklear v. Shinseki, 24 Vet. App. 311 (2011) (bifurcation of a claim generally is within VA’s discretion). In February 2017, this case was initially before the Board. In February 2017, the Board denied entitlement to an effective date earlier than February 21, 2012 for the award of service connection for erectile dysfunction and for the award of special monthly compensation due to loss of creative organ, granted entitlement to service connection a left leg disability, denied entitlement to a compensable initial evaluation for erectile dysfunction, denied entitlement to an initial evaluation in excess of 40 percent for residuals of a urethroplasty, reopened a claim for service connection for psoriatic arthritis, claimed as psoriatic arthritis and psoriasis and remanded the claim for consideration of entitlement on the merits, remanded entitlement to an evaluation in excess of 40 percent for degenerative disc disease of the lumbar spine, entitlement to an initial evaluation in excess of 30 percent for mood disorder with depression, entitlement to service connection for cervical spine disability, and entitlement to a TDIU and DEA under Chapter 35 prior to November 22, 2010, for further development. In October 2018, the Veteran’s representative requested a copy of the Veteran’s claims file, which was provided in November 2018. In December 2018, the Veteran’s representative requested an extension of 90 days from the date of the certification letter. Also, in December 2018, the Veteran’s representative again requested a copy of the Veteran’s claims file. In January 2019, VA contacted the Veteran’s representative to verify if the December 2018 request for claims file was still necessary or if they had received the prior copy. VA was advised that the prior copy had been received, and that there were no other pending or unfulfilled requests outstanding. Thus, as the Veteran’s representative confirmed there were no outstanding requests for copies of the claims file, as a further extension of time has not been requested, and as the prior extension of time has elapsed, the Board may proceed with appellate review. As a final initial matter, since the most recent April 2018 supplemental statement of the case (SSOC) issued for a portion of the appeal issues, additional evidence in the form of additional VA treatments records, has been associated with the claims file, for which the Veteran did not waive review by the Agency of Original Jurisdiction (AOJ). However, as the additional evidence is either duplicative or not relevant to the appeal issues adjudicated in the April 2018 SSOC, a remand for the additional evidence to be considered by the AOJ is not warranted. Earlier Effective Date The assignment of effective dates of awards 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 or a claim reopened after final adjudication 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). The implementing regulation clarifies this to mean that the effective date of service connection based on an original claim or reopened claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 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. The amendments also, inter alia, eliminate 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, 3.157. However, the amended regulations do not apply to this appeal as it was initiated prior to March 24, 2015. In this regard, a pre-amendment “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See 38 C.F.R. § 3.1 (p); see also Brannon v. West, 12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Determining an appropriate effective date for an increased rating under the effective date 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); see also Hazan v. Gober, 10 Vet. App. 511 (1997). The United States Court of Appeals for Veterans Claims (Court), has held that the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). In order to obtain an increased disability rating earlier than the date of the claim, the evidence must show that the increase in disability occurred within the one-year period prior to the date of claim. If the evidence showed that the increase occurred earlier than one year prior to the date of the claim, then, the effective date is no earlier than the date of the claim. Generally, a Board decision is final on the date stamped on the face of the decision. 38 U.S.C. § 7104; 38 C.F.R. § 20.11000. Further, the Court has stated that an effective date for an increased rating could be prior to a final Board decision if the “ascertainable” increase was shown within one year of the date of claim and the “ascertainable” date preceded the Board decision (and the grant was not based upon the same evidence of record at the time of the prior Board decision). Hazan, 10 Vet. App. at 519-21. 1. Entitlement to an effective date prior to March 11, 2008, for the grant of service connection for peripheral neuropathy of the left lower extremity A December 2017 rating decision effectuated a February 2017 Board grant of service connection for a left leg disability. The December 2017 rating decision granted service connection for peripheral neuropathy of the left lower extremity effective March 11, 2008. The December 2017 rating decision established an effective date of March 11, 2008, because the Veteran’s informal claim for benefits, which included a claim for a left leg disability, was received by VA on March 11, 2008. Specifically, in the March 11, 2008 informal claim, the Veteran requested VA to please evaluate service connection for loss of strength in his left leg secondary to his service-connected degenerative disc disease. Thus, the informal application for benefits was received on March 11, 2008, more than a year after the Veteran’s separation from active service in July 1967. The evidence of record does not contain any statement or other indication that the Veteran demonstrated an intent to apply for VA benefits for peripheral neuropathy of the left lower extremity prior to March 11, 2008. Thus, even if the Veteran’s peripheral neuropathy of the left lower extremity onset prior to March 11, 2008, such would not provide for an earlier effective date as the effective date is the later of the date of claim or the date the disability arose. 38 C.F.R. § 3.816 (c)(2). Consequently, under applicable law, outlined above, the effective date of the subsequent award cannot be prior to March 11, 2008. However, the Board recognizes that the Veteran was granted service connection for peripheral neuropathy of the left lower extremity secondary to his service-connected lumbar spine disability. Secondary service connection is granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. In this regard, prior to the Veteran’s March 11, 2008 informal claim, in a July 13, 2007 decision, the Board denied entitlement to a rating in excess of 40 percent for the Veteran’s service-connected degenerative disc disease of the lumbar spine. In the July 2007 decision, the Board specifically found there was no basis for the assignment of a separate rating for neurologic manifestations resulting from the Veterans lumbar spine disability. The Board found that there was no clear demonstration that the Veteran had radiculopathy attributable to the degenerative disc disease of the lumbar spine, and further, given that the left thigh and left buttock had specifically been diagnosed with some degree of neurologic impairment, that under the pertinent rating criteria, such would be evaluated as noncompensable. The Veteran did not appeal the July 2007 decision to the United States Court of Appeals for Veterans Claims (Court), and it is final. 38 U.S.C. § 7104. Although the July 2007 decision denied a higher rating for the Veteran’s lumbar spine disability, the Board finds that a claim for service connection for peripheral neuropathy of the left lower extremity was implicitly denied by that decision. The “implicit denial” rule provides that in certain circumstances, a claim for benefits will be deemed to have been denied, and thus finally adjudicated, even if VA did not expressly address that claim in its decision. Adams v. Shinseki, 568 F.3d 956, 961 (Fed. Cir. 2009). The implicit denial rule is, at bottom, a notice provision. Id. at 965. In Cogburn v. Shinseki, 24 Vet. App. 205 (2010), the Court set forth four factors that must be considered when determining whether a claim was implicitly denied: (1) The relatedness of the claims; (2) whether the adjudication alluded to the pending claim in such a way that it could reasonably be inferred that the prior claim was denied; (3) the timing of the claims; and (4) whether the claimant is represented. Id. at 212-214. In this case, each of the Cogburn factors has been met. In regard to the first factor, peripheral neuropathy of the left lower extremity is related to the lumbar spine claim, and was part and parcel of the claim for an increased rating for the lumbar spine disability, as neurological symptoms are specifically noted in the rating criteria for a lumbar spine disability. See 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note (1). In regard to the second factor, the July 2007 Board decision specifically discussed peripheral neuropathy of the left lower extremity. In the July 2007 decision, the Board found that the Veteran was not entitled to a separate rating for any neurological component of his low back disability, as there was no objective evidence of any neurological manifestations since the effective date of service connection. The Board noted the Veteran had complained of neurological manifestations, but objective manifestations were not demonstrated. Regarding the third factor, the timing of the claims, the July 2007 Board decision specifically found the Veteran’s left thigh and left buttock had been diagnosed with some degree of neurologic impairment. As neurological symptoms are part of a claim for a higher rating for a low back disability under the rating criteria for the lumbar spine, the claims were filed simultaneously. For the fourth factor, the Veteran at that time was represented by the Disabled American Veterans, a Veterans Service Organization (VSO). VA is required to read filings liberally when a claimant is either pro se or represented by a VSO. Roberson, 251 F.3d 1378. Even reading the filings liberally, the Board finds that the July 2007 Board decision implicitly denied a claim for left lower extremity radiculopathy. As the July 2007 Board decision is final, the Board finds the November 2004 claim for an increased evaluation for the lumbar spine disability, and which led to the July 2007 Board decision, cannot serve as the basis for an earlier effective date. As noted above, an effective date for an increased rating could be prior to a final Board decision if the “ascertainable” increase was shown within one year of the date of claim (and the “ascertainable” date preceded the Board decision). Hazan, 10 Vet. App. at 519-21. The claim for service connection for a left leg disability, as discussed above, arose out of the Veteran’s own March 11, 2008 informal claim which also included a claim for increase for his service-connected lumbar spine disability. As peripheral neuropathy of the left lower extremity is a manifestation of the Veteran’s service-connected lumbar spine disability, the Board has considered if an earlier effective date may be granted on the date of a factually ascertainable increase in symptoms, if such increase occurred within the one-year period preceding the date of the claim, and finds that it was not factually ascertainable. The evidence of record within the one-year period preceding the date of the March 11, 2008 claim, but not prior to the July 13, 2007 Board decision, does not support a finding that the Veteran was diagnosed with a disability of the left leg as related to his lumbar spine disability within this period. This evidence includes an August 2007 VA treatment record which noted, in part, that as to the Veteran’s complaints of chronic lower extremity pain/numbness, he had been diagnosed with meralgia paresthetica in the past and that an EMG done last year, in April 2006, showed mild abnormalities noted in lumbar paraspinals only that might be suggestive, but was not diagnostic, of a lower lumbar radiculopathy. Significantly, as described, this record did not endorse a diagnosis of radiculopathy. Further, the April 2006 EMG was of record at the time of the July 2007 Board decision, and meralgia paresthetica was specifically discussed by the July 2007 Board decision. Thereafter, a May 2008 VA treatment record provided an impression of probable left L4 radiculopathy due to facet arthropathy of L3-L4, L4-L5, facet degenerative joint disease, mild multilevel lumbar and degenerative disc disease. However, the May 2008 VA treatment record which provided possible impression of left lower extremity radiculopathy, as relevant to a diagnosis of a left leg disability which was secondary to his service-connected lumbar spine disability, is dated after the March 11, 2008 informal claim and thus does not provide for an earlier effective date. The Veteran has not identified a specific date he believes should be the proper effective date or provided a basis for an earlier effective date for the Board to consider. Based on the foregoing, the Board concludes that an earlier effective date is not warranted in this case under VA regulations governing effective dates for the award of service connection as applied to the relevant facts. As such, the Board finds that the preponderance of the evidence is against the Veteran’s claim for an earlier effective date for the award of service connection for peripheral neuropathy of the left lower extremity. Consequently, the benefit of the doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection Generally, service connection may be established 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. To establish service connection on a direct incurrence basis, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for disability that is proximately due to, or aggravated beyond natural progression by, service-connected disease or injury. 38 C.F.R. § 3.310. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Certain chronic diseases, including arthritis, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Additionally, service connection on the basis of continuity of symptomatology can be established for the chronic diseases specified 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 2. Entitlement to service connection for service connection for psoriatic arthritis, to include as secondary to service-connected degenerative disc disease of the lumbar spine The Veteran asserts service connection for psoriatic arthritis is warranted. Specifically, in his March 2008 informal claim, the Veteran claimed service connection for psoriatic arthritis as secondary to service-connected degenerative disc disease of the lumbar spine. The question for the Board is whether the Veteran has a current disability of psoriatic arthritis that manifested to a compensable degree in service or within the applicable presumptive period, whether continuity of symptomatology has existed since service, or whether it is otherwise related to service, or proximately due to, or aggravated beyond natural progression by, service-connected degenerative disc disease of the lumbar spine. While the Veteran has a current disability of psoriatic arthritis, as such was diagnosed by a December 2017 non-degenerative arthritis and dysbaric osteonecrosis disability benefits questionnaire, which is a chronic disease under 38 U.S.C. § 1101 (3) and 38 C.F.R. § 3.309 (a), it was not shown to be chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. In this regard, review of the Veteran’s service treatment records does not reflect any documentation of psoriatic arthritis, or complaints thereof. Additionally, the Veteran’s June 1967 examination, provided in conjunction with his separation from active service, did not note any defect or diagnosis with respect to psoriatic arthritis. Further, the Veteran has not reported his psoriatic arthritis onset during service and continued after service, or that it onset within one year after separation from service. In fact, conversely, the December 2017 non-degenerative arthritis and dysbaric osteonecrosis disability benefits questionnaire documented that the Veteran reported he started developing rheumatoid arthritis with characteristic joint deformities in the hand and fingers since 1983. Further, consistent with the Veteran’s recollection, his VA treatment record generally reflect complaints of psoriatic arthritis in the mid-1980s. In this regard, a June 1984 VA treatment record provided an assessment, in part, of rheumatoid arthritis with tenosynovitis, a July 1984 VA treatment record documented an impression of polyarticular arthritis, and an August 1984 VA treatment record documented severe, painful, seronegative arthritis since January 1984. Similarly, November 2004, June 2005, October 2005, February 2006 and July 2006 VA treatment records noted, in part, the Veteran had a history of psoriatic arthritis diagnosed in 1984. Thus, assuming the Veteran’s psoriatic arthritis onset in 1983 or 1984, such is decades after his separation from service and decades outside of the applicable presumptive period. Further, the prolonged period of many years between the earliest evidence of the onset of psoriatic arthritis in 1983 or 1984 and the Veteran’s separation from service in July 1967 without complaints and/or treatment for the disability at issue is evidence for consideration in determining continuity of symptomatology and weighs against a claim herein. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). Further, a September 1968 VA examination report documented other complaints but did not indicate any psoriatic arthritis or complaints thereof. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist). Service connection for psoriatic arthritis may still be granted on a nonpresumptive direct incurrence basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s psoriatic arthritis and an in-service injury, event or disease. In this regard, the December 2017 examiner opined that the Veteran’s psoriatic arthritis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was there was no evidence showing treatment for condition or complaint involving the claimed condition during military service. The December 2017 examiner noted the medical treatment records failed to show this condition developed during the service years and a nexus has not been established. Service connection for psoriatic arthritis may still be granted on a secondary basis; however, the preponderance of the evidence is against finding that a Veteran’s psoriatic arthritis was caused by or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. In this regard, the December 2017 examiner found it was not likely that psoriatic arthritis was either caused by or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. In support of such, the December 2017 examiner cited to the objective evidence and lack of collaboration from medical literature. Further, the December 2017 examiner’s findings are consistent with a November 2008 examiner’s impression that the Veteran’s psoriatic arthritis was unrelated to service or lumbar spine disease. The December 2017 examiner’s opinion on a direct incurrence and secondary basis are probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As noted above, the Veteran believes his psoriatic arthritis is related to service or is secondary to service-connected degenerative disc disease of the lumbar spine; however, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical education. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the December 2017 examiner’s opinions. In sum, the Board has reviewed the evidence of record, as well as the pertinent law and regulations, but finds that the preponderance of the evidence is against the Veteran’s claim for service connection for psoriatic arthritis. Thus, service connection for psoriatic arthritis is denied. In reaching the above conclusion the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for service connection for psoriatic arthritis, that doctrine is not for application. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-56. 3. Entitlement to service connection for psoriasis, to include as secondary to service-connected degenerative disc disease of the lumbar spine The Veteran asserts service connection for psoriasis is warranted. Specifically, in his March 2008 informal clam, the Veteran claimed psoriasis as secondary to service-connected degenerative disc disease of the lumbar spine. The question for the Board is whether the Veteran has psoriasis that began during service, is at least as likely as not related to an in-service injury, event, or disease, or is proximately due to or chronically aggravated beyond natural progression by service-connected degenerative disc disease of the lumbar spine. The Board concludes that, while the Veteran has a current diagnosis of psoriasis, as such was diagnosed by a December 2017 skin diseases disability benefits questionnaire, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis psoriasis began during service, is otherwise related to service, or is proximately due to or chronically aggravated beyond natural progression by service-connected degenerative disc disease of the lumbar spine. In this regard, review of the Veteran’s service treatment records does not reflect any documentation of psoriasis, or complaints thereof. In this regard, the Veteran’s June 1967 examination, provided in conjunction with his separation from active service, did not note any defect or diagnosis with respect to psoriasis and his skin was reported to be clinically normal upon examination. Further, Board finds that if the Veteran had experienced psoriasis while in service, it would have been reasonable for him to have reported it, and sought treatment for it, during service, especially as he sought treatment for multiple other medical conditions; however, there is no record of any complaints or treatment related to psoriasis. See Buczynski, 24 Vet. App. at 224. Further, the record does not reflect a diagnosis of psoriasis until many years after service. In this regard, a September 1968 VA examination report documented in part, that the Veteran’s skin, including appendages, was normal. Further, a May 1987 VA treatment record documented, in part, no change in psoriasis over the ears and the back of head; however, in prior April 1987 and subsequent June 1987 VA treatment records the Veteran denied a rash. Further, the prolonged period of many years between the earliest evidence of the onset of psoriasis in 1987 and the Veteran’s separation from service in July 1967 without complaints and/or treatment for the disability at issue is evidence for consideration in determining continuity of symptomatology and weighs against a claim herein. See Mense, 1 Vet. App. at 356. The December 2017 examiner opined that the Veteran’s psoriasis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support of such, the December 2017 examiner noted the Veteran’s service treatment records did not note that the condition was present, treated or diagnosed, or acquired while in service. The December 2017 examiner explained that psoriasis was an autoimmune chronic inflammatory skin disease known to be triggered by streptococcal and HIV infections and reiterated there was no evidence of this disability during military service. Service connection for psoriasis may still be granted on a secondary basis; however, the preponderance of the evidence is against finding that a Veteran’s psoriasis was caused by or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. In this regard, the December 2017 examiner found it was not likely that psoriasis was either caused by or chronically aggravated by service-connected degenerative disc disease of the lumbar spine. In support of such, the December 2017 examiner cited to the objective evidence and lack of collaboration from medical literature. Further, the December 2017 examiner reiterated that psoriasis was an autoimmune chronic inflammatory skin disease known to be triggered by streptococcal and HIV infections and therefore the back condition did not cause or aggravate the psoriasis. The December 2017 examiner’s opinions on a direct incurrence and secondary basis are probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. As noted above, the Veteran believes service connection for psoriasis is warranted, including as secondary to his service-connected degenerative disc disease of the lumbar spine; however, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires interpretation of specialized medical education. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377; see also Kahana, 24. Vet. App at 435. Consequently, the Board gives more probative weight to the December 2017 examiner’s opinions. In sum, the Board has reviewed the evidence of record, as well as the pertinent law and regulations, but finds that the preponderance of the evidence is against the Veteran’s claim for service connection for psoriasis. Thus, service connection for psoriasis is denied. In reaching the above conclusion the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for service connection for psoriasis that doctrine is not for application. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-56. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). VA must consider whether to “stage” the rating, meaning assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. Consideration of the appropriateness of a staged rating is required for increased rating claims, irrespective of whether it is an initial rating at issue or instead an established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 4. Entitlement to an initial evaluation in excess of 20 percent for peripheral neuropathy of the left lower extremity As discussed above, a December 2017 rating decision granted service connection for peripheral neuropathy of the left lower extremity effective March 11, 2008. Thus, the appeal period for consideration is from March 11, 2008. Throughout the rating period on appeal, Veteran’s peripheral neuropathy of the left lower extremity has been assigned a 20 percent disability rating under Diagnostic Code 8520, which governs paralysis of the sciatic nerve. Neurological disability is evaluated on the basis of nerve paralysis, partial paralysis, neuritis or neuralgia in proportion to the impairment of motor or sensory function. 38 C.F.R. §§ 4.120-4.124a. Under Diagnostic Code 8520, mild incomplete paralysis warrants a 10 percent rating; moderate incomplete paralysis warrants a 20 percent rating; moderately severe incomplete paralysis warrants a 40 percent rating; and severe incomplete paralysis warrants a 60 percent rating. Complete paralysis of the sciatic nerve warrants an 80 percent rating, but requires that the foot dangles and drops, no active movement possible of muscles below the knee, flexion of the knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, the rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis,” with respect to peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the lesion or to partial regeneration. Where the involvement is wholly sensory, the rating should be for mild, or at the most, moderate symptomatology. 38 C.F.R. § 4.124a. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, can receive a maximum rating of moderate incomplete paralysis, except for tic douloureux or trifacial neuralgia, which may be rated up to complete paralysis. 38 C.F.R. § 4.124. Additionally, in rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. Special consideration should be given to any psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, and injury to the skull. 38 C.F.R. § 4.120. The words “slight,” “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Turning to the evidence of record, a November 2008 examiner documented a sensory examination showed a significant decrease, and in some cases, loss of sharp sensation on the anterolateral, lateral, and posterolateral left thigh; however, a sensory examination in the legs and feet was completely intact, from sharp to dull. The November 2008 examiner provided an impression that there was no evidence of nerve root entrapment, and none evident on MRI, and further noted weakness of both lower extremities, as documented, but unrelated to lumbar spine disease, and explained that the MRI was clean in terms of not showing any stenosis or nerve impingement. The November 2008 examiner also diagnosed meralgia paresthetica of the left lateral femoral cutaneous nerve that was not related to his spine and noted that such was commonly seen in very obese people. Similarly, a December 2008 VA general examiner found with respect to neurological examination, sensation was intact in the lower extremities and motor strength was 5 out of 5. A May 2015 back conditions disability benefits questionnaire found the Veteran’s sensation to light touch (dermatome) testing of the left upper anterior thigh (L2), left thigh/knee (L3/4), left lower leg/ankle (L4/L5/S1), and left foot/toes (L5) were all decreased. The May 2015 examiner also found the Veteran’s deep tendon reflexes as to his left knee was hypoactive and as to his left ankle was absent. The May 2015 examiner found muscle strength testing as the Veteran’s left knee extension, left ankle plantar flexion, left ankle dorsiflexion, and left great toe extension were all characterized as active movement with gravity eliminated but there was no muscle atrophy. Further, the May 2015 examiner found the Veteran did not have intermittent pain or paresthesias and/or dysesthesias, but did have constant pain and numbness of the left lower extremity, both characterized as moderate. The May 2015 examiner found there was nerve root involvement as to L4/L5/S1/S2/S3, for the left sciatic nerve of moderate severity. A February 2017 back conditions disability benefits questionnaire found the Veteran’s sensation to light touch (dermatome) testing of the left upper anterior thigh (L2) and left thigh/knee (L3/4) were normal but the left lower leg/ankle (L4/L5/S1), and left foot/toes (L5) were decreased. The February 2017 examiner also found the Veteran’s deep tendon reflexes as to his left knee was hypoactive and as to his left ankle was normal. The February 2017 examiner found muscle strength testing as the Veteran’s left hip flexion, left knee extension and great toe extension were normal, but ankle plantar extension and ankle dorsiflexion were noted to have active movement against some resistance; however, there was no muscle atrophy. The February 2017 examiner found the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. A February 2017 peripheral nerves conditions disability benefits questionnaire found the Veteran’s sensation to light touch testing of the left upper anterior thigh (L2), left thigh/knee (L3/4), lower leg/ankle (L4/L5/S1), and foot/toes (L5) were all normal. The February 2017 examiner also found the Veteran’s deep tendon reflexes as to his left knee was hypoactive and as to his left ankle was normal. The February 2017 examiner found muscle strength testing as the Veteran’s left knee extension was normal but left ankle plantar flexion and left ankle dorsiflexion were noted to have active movement against some resistance; however, there was no muscle atrophy. The February 2017 examiner found as to the left lower extremity, the Veteran had mild symptoms of constant pain, paresthesias and/or dysesthesias, and numbness and moderate symptoms of intermittent pain. The February 2017 examiner found mild incomplete of the left sciatic nerve. A December 2017 back conditions disability benefits questionnaire found the Veteran’s sensation to light touch (dermatome) testing of the left upper anterior thigh (L2) and left thigh/knee (L3/4), left lower leg/ankle (L4/L5/S1), and left foot/toes (L5) were decreased. The December 2017 examiner also found the Veteran’s deep tendon reflexes as to his left knee and his left ankle were normal. The December 2017 examiner found muscle strength testing as the Veteran’s left hip flexion and left knee extension were noted to have active movement against some resistance, and ankle plantar extension, ankle dorsiflexion and great toe extension were normal; however, there was no muscle atrophy. The December 2017 examiner found as to the left lower extremity, the Veteran did not have symptoms of intermittent pain but did have mild symptoms of constant pain, paresthesias and/or dysesthesias, and numbness. The December 2017 examiner also noted the Veteran had numbness, pain and tingling of his left lower extremity. The December 2017 examiner found there was nerve root involvement as to L4/L5/S1/S2/S3, for the left sciatic nerve of mild severity. In review of the evidence, the probative evidence demonstrates the Veteran’s left lower extremity is a disability of the sciatic nerve, based on findings of the May 2015, February 2017 and December 2017 examiners. Thus, the Board finds that Diagnostic Code 8520, for paralysis of the sciatic nerve, is the most appropriate Diagnostic Code with respect to the nerve at issue. Copeland v. McDonald, 27 Vet. App. 333 (2015). The Board has also considered whether higher ratings are available under the regulations pertaining to neuritis and neuralgia. In terms of neuritis, May 2015 and February 2017 examiners did find a decrease in reflexes and the May 2015, February 2017 and December 2017 examiners also each found sensory disturbance and constant pain characterized twice as mild and once moderate. Additionally, although the November 2008 examiner did not endorse any radiculopathy or decrease in reflexes, sensory disturbance was noted. However, none of the examiners endorsed a finding of muscle atrophy, thus a higher evaluation under Diagnostic Code 8620 is not warranted at any point during the appeal period. Similarly, in terms of neuralgia, the May 2015 and December 2017 examiners did not endorse findings of intermittent pain. Further, while the February 2017 examiner found moderate symptoms of intermittent pain, such would not provide for a higher evaluation as the Veteran is already assigned an evaluation for moderate symptoms during the entire appeal period, thus a higher evaluation under Diagnostic Code 8720 is not warranted at any point during the appeal period. Further, moderate incomplete paralysis is the maximum rating provided for the sciatic nerve under Diagnostic Code 8720. 38 C.F.R. § 4.124. Additionally, the clinical treatment records throughout the rating period for consideration are largely consistent with the findings in the disability benefits questionnaires dated during the appeal period and do not demonstrate additional symptoms associated with the Veteran’s service-connected peripheral neuropathy of the left lower extremity and applicable to the rating criteria that would warrant higher evaluations at any point during the appeal period. For example, a March 2010 VA treatment record documented the Veteran’s complaint of chronic worsening numbness to left lower leg and pain/numbness from left hip radiating down left lateral thigh to the knee and a November 2014 VA treatment record noted the Veteran currently complained of pain in left extremity with associated numbness and burning sensation radiating from the back to left buttock to leg and stopping around the ankle. In weighing the evidence, the Board finds Veteran’s symptoms of peripheral neuropathy of the left lower extremity more closely approximate the evaluation of 20 percent, for moderate incomplete paralysis of the sciatic nerve throughout the appeal period. In this regard, as discussed above, two examiners characterized this disability as mild, specifically a February 2017 examiner found mild incomplete of the left sciatic nerve and the December 2017 examiner found mild radiculopathy of the left sciatic nerve, and only one examiner, specifically the May 2015 examiner found moderate radiculopathy of the left sciatic nerve. The Board notes that the Veteran is competent to report symptoms of numbness, pain and tingling of his left lower extremity as documented in the evidence of record, including in the December 2017 back conditions disability benefits questionnaire. See Layno, 6 Vet. App. at 469. However, the Board affords greater probative weight to the findings of the numerous VA examiners who personally examined the Veteran and applied their medical expertise. In particular, as discussed above, two examiners characterized this disability as mild and only one characterized it as moderate. Further, throughout the rating period on appeal, the clinical evidence of record does not demonstrate, nor indicate that the disability at issue has been medically characterized as moderately severe incomplete nerve paralysis or worse, even with consideration of the Veteran’s subjective complaints. In sum, the Board finds that the Veteran’s symptoms of left sciatica nerve involvement most closely approximated, at worst, an evaluation of 20 percent under Diagnostic Code 8520. In making this determination, the Board considered the application of “staged” ratings, but found no additional distinctive periods where the Veteran’s service-connected peripheral neuropathy of the left lower extremity met or nearly approximated the criteria for an evaluation in excess of 20 at any point during the appeal period. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, to the extent the preponderance of the evidence is against an evaluation higher than or separate from that already assigned for peripheral neuropathy of the left lower extremity, the doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55-56. Additionally, although the issue of entitlement to a TDIU prior to November 22, 2010 is remanded below, the Board is not maintaining divergent positions concerning the completeness of the record. See Brambley v. Principi, 17 Vet. App. 20, 24 (2003). Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with his respect to his peripheral neuropathy of the left lower extremity. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 5. Entitlement to an initial evaluation in excess of 30 percent for mood disorder with depression due to a general medical condition The Veteran contends his mood disorder with depression is more severe than currently evaluated and that the assignment of a higher evaluation is warranted. A December 2011 rating decision, in part, granted service connection for service connection for mood disorder with depression due to a general medical condition effective November 22, 2010. Thus, the appeal period for consideration is from November 22, 2010. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of functional impairment required for a disability rating of 50 percent or higher. The Board concludes that the Veteran’s symptoms do not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran’s symptoms more closely approximate the symptoms associated with a 30 percent rating, and result in a level of functional impairment that most closely approximates the level of impairment associated with a 30 percent rating. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. VA treatment records, the April 2011, May 2015, and January 2018 VA examinations, and the Veteran’s lay statements show that the Veteran’s mood disorder with depression disorder was manifested by symptoms associated with a 30 percent rating such as depressed mood, anxiety, chronic sleep impairment, and symptoms associated with a 50 percent rating such as panic attacks several times per week and a lack of motivation. He also had symptoms that are not listed with a specific rating, such as agitation, irritability, hopelessness, difficulty making simple decisions and physical pain that impacted his mood. The Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. Specifically, these symptoms were not present throughout the appeal period but were only documented infrequently, such as in the April 2011 examination report or June 2011 addendum. Further, to the extent the April 2011, May 2015, and January 2018 examiners endorsed differing psychiatric diagnoses, or as the Veteran’s VA treatment records, including those dated from July 2009 to July 2017, which provided a diagnosis of major depressive disorder, reflected other psychiatric diagnosis other than mood disorder with depression, all findings as to the Veteran’s psychiatric symptomology have been considered as part of the Veteran’s service-connected mood disorder with depression, irrespective of the particularly identified disorder. See Mittleider v. West, 11 Vet. App. 181 (1998). The Veteran is competent to report observations with regard to the severity of his symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds these lay statements to be credible and consistent with the rating assigned. To the extent he argues his symptomatology is more severe, the Veteran’s statements must be weighed against the other evidence of the record. Jandreau, 492 F.3d at 1377. The Board gives more probative weight to the clinical medical records, including the April 2011, May 2015, and January 2018 VA examinations reports. The Board notes that the Veteran expressed suicidal ideation, which is contemplated by the 70 percent criteria and is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 70 percent or 100 percent disability ratings. The Veteran reported experiencing suicidal ideation in an isolated instance during the pendency of the appeal, specifically during in the April 2011 examination in which he reported primarily fleeting suicidal ideation but further stated he would not do it because of the relationship with his pet dog. Further, he denied suicidal ideation in existing treatment records, and during the May 2015 and January 2018 VA examinations. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. In this regard, the April 2011 examiner opined the Veteran’s mental disorder was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally function satisfactorily with routine behavior, self-care and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Thereafter, the May 2015 and January 2018 examiners each found the Veteran’s mental disorder was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. While the Veteran did experience symptoms contemplated by a 50 percent rating, such as panic attacks several times per week, such were characterized as mild and such were only reported in the April 2011 examination. Further, although a November 2013 VA treatment record noted the Veteran reported, in part, he lacked motivation, such was not consistently documented throughout the appeal period. Thus, evidence overall does not demonstrate the level of impairment associated with a 50 percent rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 30 percent rating. In sum, the Board finds that the Veteran’s symptoms as to his mood disorder with depression most closely approximated, at worst, an evaluation of 30 percent throughout the appeal period. In making this determination, the Board considered the application of “staged” ratings, but found no additional distinctive periods where the Veteran’s service-connected mood disorder with depression met or nearly approximated the criteria for an evaluation in excess of 30 at any point during the appeal period. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, to the extent the preponderance of the evidence is against an evaluation higher than that already assigned for mood disorder with depression, the doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55-56. Additionally, although the issue of entitlement to a TDIU prior to November 22, 2010 is remanded below, as noted above, the appeal period for consideration for the initial evaluation for mood disorder with depression is from November 22, 2010, and as TDIU has been granted from November 22, 2010, these matters are not intertwined. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with his respect to his mood disorder with depression. See Doucette, 28 Vet. App. at 369-70. REASONS FOR REMAND 1. Entitlement to service connection for cervical spine disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. Pursuant to a February 2017 Board remand which directed, in part, that an opinion be obtained to address the claim as secondary to service-connected degenerative disc disease of the lumbar spine, a December 2017 examiner noted that while the Veteran’s back condition occurred in service, his cervical condition occurred 15 years post military service, and therefore, the back condition could not have aggravated the cervical spine condition beyond its natural progression as they are separate entities. However, this reasoning relies upon inaccurate logic, for instance, no explanation was provided as to why degenerative disc disease of the lumbar spine could not subsequently cause or aggravate a cervical spine disability, even 15 years later. Thus, an addendum opinion is warranted. 2. Entitlement to an evaluation in excess of 40 percent for degenerative disc disease of the lumbar spine (with the exception of a period of a temporary total convalescence rating pursuant to 38 C.F.R. § 4.30) is remanded. While the record contains a contemporaneous December 2017 VA examination regarding the Veteran’s degenerative disc disease of the lumbar spine, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). Specifically, the December 2017 examiner was unable to say without mere speculation as to if pain, weakness, fatigability, or incoordination significantly limit functional ability with flare-ups. As the examiner did not indicate that the speculation was due to lack of knowledge within the medical community, the Board finds another examination is warranted. 3. Entitlement to a TDIU prior to November 22, 2010 is remanded. The issue of entitlement to TDIU prior to November 22, 2010 is intertwined with the above remanded claim for an increased rating for degenerative disc disease of the lumbar spine, as such could affect whether the Veteran meets the schedular criteria for a TDIU, as he currently does not satisfy the schedular criteria prior to November 22, 2010. Thus, a remand is warranted for the TDIU claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). 4. Entitlement to an effective date prior to November 22, 2010, for the grant of basic eligibility for DEA under Chapter 35 is remanded. The claim for effective date prior to November 22, 2010, for the grant of basic eligibility for DEA under Chapter 35, is intertwined with the claim for entitlement to a TDIU prior to November 22, 2010 remanded above, thus, a remand is also warranted for this claim. Id. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran has a cervical disability which is at least as likely as not (1) proximately due to service-connected degenerative disc disease of the lumbar spine, or (2) aggravated beyond its natural progression by service-connected degenerative disc disease of the lumbar spine. Rationale must be provided for the opinion proffered. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected degenerative disc disease of the lumbar spine. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Range of motion findings, including due to pain, must be reported in degrees, on active and passive motion, and on weight-bearing and nonweight-bearing. 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 and after repeated use. To the extent possible, the examiner should identify all symptoms and functional impairment due to degenerative disc disease of the lumbar spine alone and discuss the effect of the Veteran’s degenerative disc disease of the lumbar spine 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. 3. Thereafter, readjudicate the issues on appeal. If any benefit sought is not granted, furnish the Veteran and his representative with a supplemental statement of the case   and afford them an opportunity to respond before the record is returned to the Board for further review. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Espinoza, Counsel